News release from the Council on Aging
One of my heroes, Robert F. Kennedy, once said, “The purpose of life is to contribute in some way to make things better.” Last year, all of us here at the Milton Council on Aging became aware of a growing unfairness being imposed on our elderly. It was called “Observation Status” and it is a term that many seniors don’t know about until it is too late. So began our ongoing crusade to let everyone we met learn about Observation Status and what you need to ask if you are in a hospital. Years ago, Observation Status meant a short stay in the ER until it could be determined if you needed to be admitted. Now it can be as long as 8 days in a hospital without being considered a full hospital admit. No matter how long you stay in the hospital under Observation Status you are considered an outpatient. If you need to go to rehab for further treatment, you can be held responsible for thousands of dollars on your own that Medicare will not cover.
A few months ago, I meet with Congressman Stephen Lynch and talked with him about this growing problem. I asked if he could come to Milton and give us an update on the issue from a federal perspective. Congressman Lynch agreed and he will be here on Friday, April 11th at 11:30AM to give us that update. He will be joined by the new President and CEO of Beth Israel Deaconess Hospital-Milton, Peter Healy, and one of the most dedicated advocates in this battle, Attorney Diane Paulson, who spearheads the Medicare Advocay Project at Greater Boston Legal Services. This is a presentation you don’t want to misss!!!!!
What started out with two frustrated elder advocates here in Milton has taken on a life of its own. There was an in-depth story in the Patriot Ledger, a front page story in the Boston Globe, and even a segment on the NBC Nightly News. It just goes to show that you can make a difference and your voice can be heard. We know this will be a very well attended presentation so we are asking you to call and register for the program.
Special thanks to Congressman Lynch, Peter Healy, and Attorney Paulson for taking time out of their busy schedules to speak to the seniors about this important issue.
Can you tell us the time and location of this important meeting?
Also I was reading in the Globe that Hospitals have 1 year to change the status of a patient from inpatient to Observation which I think is quite unfair.
Barbara
Ms. Mason
To confirm — the session is at the Council on Aging on April 11 at 11:30.
I expect that much of this will come out at the meeting but the decision as to how patients are classified (outpatient v observation) is NOT something determined by the hospital. The criteria for the classification are set by federal law. Hospitals are mandated to classify patients as “observation” unless they can meet the inpatient criteria. Hospitals are closely watched and aggressively audited by federal contractors to ensure that people are not classified as inpatient when they may not meet the criteria. Further, the standards for classification are becoming increasingly strict.
Hospitals, such as BID-Milton, clearly understand the inequities of the system but unfortunately do not control these classifications or their implications. I think what we try to do– and this program is a good move in that direction– is help educate people about the rules and their implications.
Tony Cichello, BID-Milton Board member
Recently an elderly relative was admitted to Milton BI/D through the ER and from there to the ICU. The relative was then placed on one of the floors and received excellent medical and nursing care for the week’s stay.
However, no where on an admission or discharge paper is it noted or highlighted if the patient is in for “observation” or not.
If the government is setting those regulations they should – no must – provide a clear, recognizable process to inform the patient of that status. It cannot be left to fine print or no print at all.
It is clearly unfair and unethical for the government to play games with an individual’s health.
I can see this matter being litigated all the way to the US Supreme Court that a patient who has not been informed or his or her rights and status prior to admission is not liable for the subsequent costs.
Again, this does not seem like a hospital problem but a government problem playing games with people’s health and well being
This matter is already the subject of litigation – Bagnall v. Sibelius.
This issue is a little more complex than government regulation. Hospitals have had the right to retroactively change patient status since 2004 through their Utilization Review (UR) Committee. A patient admitted by a physician on an inpatient basis who is then reclassified by a Hospital UR must, by law, be notified of the change in their status.
One of the reasons for the increase in Observation Status is Medicare’s effort to reduce high readmission rates at some hospitals. Hospitals who have patients readmitted within 30 days are paid a reduced rate by Medicare. Patients treated under observation status do not count as readmissions since their initial visit was not as an inpatient.
More info here:
http://www.kaiserhealthnews.org/stories/2013/september/04/observation-care-faq.aspx
http://www.medicareadvocacy.org/medicare-info/observation-status/
Philip, thank you for that information.
The regulation still should not affect and cost the patient additional money.
The problem or problems here are not with the sick patient but with the doctors and hospitals who did not address or fix the problem that has reoccurred.
Why is the burden of proof shifted from the doctor/hospital to the patient? The implication with this reg is that they can change the rules after a misdiagnosis or medical error has been made – not by the patient but by trained and licensed medical professionals.
Why do they get a free pass and a do-over the cost of which is passed on to the consumer of those medical services.
Where are the medical ethics in this?