Hospitals now must tell seniors when they’re ‘under observation,’ not admitted

elderly-hospitalUncle Sam is stepping up to try to help ailing elderly patients who may get stuck with big hospital bills and gaps in their medical coverage due to a linguistic loophole. A Medicare law, newly in force, requires hospitals to tell Medicare patients that they are “under observation,” and not formally admitted. The difference to patients’ wallets can be huge.

Doctors and hospitals have jammed patients into this nightmare status to work around auditors for Medicare. Those fiscal overseers can accuse them of giving seniors inappropriate care, with the auditors then earning a share of financial penalties imposed against the hospitals and MDs; doctors called this approach bounty hunting by the private auditors hired by Medicare to ferret out waste. Advocates had hoped that stepped up scrutiny of admissions might get doctors and hospitals to treat more seniors in medical offices or with hospital outpatient services, instead of checking them into pricey hospital rooms.

But “observing” seniors, who actually could be receiving extensive care, ended up slapping them with big bills that Medicare might not cover; if they then needed to be transferred to nursing home care, Medicare also would not recognize their observation time and count it against its requirement that patients first have spent three days admitted to a hospital. Seniors and their families, then, could be liable for thousands of dollars for skilled nursing care.

The New York Times quotes Maine’s senator, who chairs the Senate Special Committee on Aging as saying, “The financial consequences of observation stays can be devastating for seniors.”

The relief that the new Medicare measure offers to seniors and their families is limited. Medicare-eligible patients now must get written notice that they have not been formally admitted and that they’re under observation; hospitals get 36 hours, however, in which to notify patients in their care for more than 24 hours as to their status. Once informed, patients or their family members must get doctors to act−that is, to admit them.

Some members of Congress on both sides of the aisles want to pass legislation that would count observation time toward Medicare’s three-day inpatient requirement so seniors could be transferred from hospitals to nursing homes and their care covered.

Some California lawmakers also are seeking to pass legislation to require hospitals to provide Medicare recipients notice “as soon as practicable” on their status, and to ensure that, while under observation, their nurse-to-patient ratios are equal to those required for inpatient treatment.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
Washingtonian Top Lawyer 2011
Avvo Rating 10.0 Superb Top Attorney Best Lawyers Firm
Contact Information