OBSERVATION OR INPATIENT

NBC BRIAN WILLIAMS ^ | SELF

[Thank You Rush]

Classifying Medicare patients admitted to hospitals can be classified as "observation status" or "inpatient." The bill that seniors will ultimately end up with depends on this classification. If they are in need of rehabilitation in a nursing home after hospitalization and the classification of "observation status" was applied to their records at the hospital, Medicare does not pay for the nursing home.

[Thank You Rush]

This link took me by surprise. It may not be a surprise to others. According to what I can find online, there have been lawsuits regarding this matter and they have been shot down. HHS gets away with fighting Medicare patients by saying hospitals and doctors are the ones who make the designation of "under observation" or "inpatient" at hospitals. Doctors and hospitals say they are under pressure from HHS to make the designation "under observation" thus making any patient who needs rehabilitation at a nursing home ineligible for the costs to be paid by Medicare.

There has been a bill submitted in the House - H. R. 1179 and if you look at the list of cosponsors for this bill, the majority of them are democrats!!! What representative could possibly be AGAINST a fair shake on this disastrous classification?

Time to shake the trees again and ask why our representatives are not behind this bill. It will go nowhere if pressure isn't brought to bear. I wrote to mine this morning (Woodall-GA) when I became aware of this video but I'm afraid I was so angry that it probably didn't make much sense.

[Thank You Rush]

https://www.govtrack.us/congress/bills/113/hr1179

There are 134 cosponsors for this bill - 111 D and 23 R

They wonder why we’re disgusted with their performance?

[Alex Murphy]

HHS gets away with fighting Medicare patients by saying hospitals and doctors are the ones who make the designation of "under observation" or "inpatient" at hospitals. Doctors and hospitals say they are under pressure from HHS to make the designation "under observation" thus making any patient who needs rehabilitation at a nursing home ineligible for the costs to be paid by Medicare.

PFL

[VeniVidiVici]

I was visiting a friend in the hospital just the other day and her roommate ran into this. The Admitting person came to her room to get her to sign some forms and explained that she was admitted as “under observation” (they were treating her for possible pneumonia), and that Medicare wasn’t going to pay unless they changed it to ‘inpatient’.

After the admitting person left I told her to make herself appear as sick as possible to include hacking away (fake if need be) anytime a nurse/doc walked into the room.

Ridiculous they have to go through this.

[arkfreepdom]

This is a nightmare for doctors. We care for the patient the same. It is a constantly changing issue and has nothing to do with care.

[The Great RJ]

Soon Medicare patients may be treated like seniors are in the UK under their socialized medicine system with the choices of being left uncared for in a hospital hallway or placed on the so-called Liverpool Pathway where they are given up as terminal and not provided care.

[buckeye49]

Hospitals also face non payment if a Medicare pt is admitted too soon after a previous admit for the same diagnosis, thus the “observation” status.

[Mom MD]

Medicare holds all the cards here. It is true I get to designate a patient inpatient or observation. BUT - if I guess wrong according to medicare rules they will not pay for the hospitalization. And they can come back many years later through something called a RAC audit and decide the patient was inappropriately classified and demand money back from the hospital

I practice full time hospital medicine, I see only hospitalized patients. Coding and admission status take up most of my time and energy, not only do I have to guess right, but I have to document adequately in the chart to back it up. Hospital case managers also weigh in on admission status. Its a giant scam by which Medicare tries not to pay for care. Once you get the rules down and become proficient at guessing what they want, they change the rules sometimes with little to no notice.

Of course Obama care will solve all these problems and I can ride my unicorn home after work.....

[grumpygresh]

All independent and small group doctors should stop taking Medicare. The coding compliance is impossible because Medicare changes the coding all the time , and the information they put out is often confusing and conflicting. This exposes the doctor to quite a bit of risk. An incorrect code is fraud until proven otherwise.
I speak from experience.

[nascarnation]

That’s easy to say, but it means a big drop in volume (gross income) for a lot of drs.

[bigbob]

Buddy had this happen over same-day surgery, insurance wouldn’t pay.

[Rusty0604]

So the surgery was actually just an observation?

[grumpygresh]

And what’s the price of your liberty?

[Battle Axe]

When I slipped on the ice and broke my leg, the hospital did surgery right away. I had dislocated the main bone off the top of the ankle and they needed to get that blood flow restarted or the bone marrow would die. I had no insurance and it happened at home. I was placed in a hospital room, in a bed, and I was under the impression that my room mate was a man. I never saw that patient, nor spoke to him as I was too busy throwing up on the nurses, but I was told it was a 300 pound woman. My bill said “observation” and I was sent home after 22 hours there. I kept asking them why they were sending me home, when I could not even get myself a glass of water.

It was explained later, that if they had written down admitted, that the bill would have been much more.

My friends took turns checking on me. I had a “grab-it” and a tiny electric frig and 4 ice packs. I could reach the dorm room size frig from my chair and could maneuver into a potty chair and somehow I survived. The hospital made an offer for about 40% if I could find some cash. Dad dipped into my inheritance and it was paid off.

Very careful today as I could never do that again.

[Thank You Rush]

According to everything I’ve found online, the same care can be given to a patient being “observed” as one admitted as an inpatient; same pharmaceuticals, tests etc. I looked and looked to find how they make the “observation” designation and I’m still looking. I don’t believe there are any qualifications for it - it’s totally arbitrary according to the dictates of the hospitals who are under pressure from Medicare.

There’s a post on the thread from an MD that is very interesting. I’m grateful she posted.

I don’t care what HHS claims and or corrupt the courts are to find in favor of HHS in the one or few cases that have been filed, the problem lies with HHS and Medicare which automatically means our BELOVED FEDERAL BUREAUCRACY!

Can you believe that MORE attention is given to this to pretend to curb costs than to the illegals soaking up the benefits never having paid a dime in taxes? Everything says they are dogged in running the cases down as to “observed” vs “inpatient”; sometimes taking years for audits to collar the CULPRITS - the big criminals...

I don’t get it. I count each day a good one when we haven’t been thrown a curve like this but those days are getting fewer and fewer.

[Thank You Rush]

Thanks for your input from a medical doctor’s perspective. I find it interesting and I’m sure others will also.

I didn’t know a unicorn came with obamacare. That sly devil! Accent on the DEVIL!!!!! Does it come with food and a stall? Is it a current model in good shape?

The stress among the patient population is high. I can’t imagine what it’s like for caregivers of all kinds.

My husband was admitted to the hospital in October after 4 1/2 hours in the ER. I had never heard of this situation before but believe me, I will be on the lookout for it in the future. He’s had 2 hospitalizations in the past 5 years with breathing problems (COPD) and probably not the kind of situation that would call for a nursing home or rehabilitation but I will fight the politicians for everyone. My job at this age is to take care of him, and let the DC politicians know what I think of them.

[Thank You Rush]

“”PFL””

Do I dare ask for a definition? I’m a senior from the ‘30’s but not easily shocked!!!

[nascarnation]

Are recommending doctors take a similar stance on govt funded VA and Tri-care?

[Thank You Rush]

“”has nothing to do with care.””

Just like obozocare, right? How gullible they think everyone is. They are if they think the country consists of nothing but people who voted the creeps in.

Remember “Where Have All the Flowers Gone?” Where has all the common sense gone???? Was it all an illusion?

[grumpygresh]

Yes, but only independent doctors. Employed doctors have less exposure (but not complete immunity) to coding risk. If the doctor has opted out of government insurance, they can see patients as self pay if feasible for the patient.