Good News on Medicare Observation Status
Many readers have emailed about this issue - one that is boring to read about but crucial to understand. First, a short background:
Medicare Observation Status has been a frightful bugaboo for beneficiaries for years. Patients can be treated in hospitals under “observation status” - often for days – without being formally “admitted.”
Hospitals do this, explains Robert Pear in The New York Times, “for fear of being penalized by Medicare for inappropriate admissions.”
What it means for patients is that they become liable for substantial hospital bills and nursing home care. Medicare payment requires three consecutive days of admission as an inpatient. As Pear tells us:
“Time spent under observation does not count toward the three days, even though the patient may spend five or six nights in a hospital bed and receive extensive hospital services, including tests, treatment and medications ordered by a doctor.”
The good news is that on Saturday, 6 August 2016, a new Medicare law went into effect. Named the NOTICE Act, it
”...requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted...
"Under the new law, the notice must be provided to 'each individual who receives observation services as an outpatient at a hospital for more than 24 hours.' Medicare officials estimate that hospitals will have to issue 1.4 million notices a year.” [emphasis is mine]
Notification will begin in January and as positive as that is, it still falls far short of protecting elders from life-crushing costs because hospitals can still keep patients under observation status as long as they notify them.
Like me, you may wonder how notification is possible if, for example, a patient arrives at a hospital in pain, bleeding or even unconscious. If I were in dire physical condition, I'm fairly certain I'd nod agreement to pretty much anything to get some relief and treatment.
Judith A. Stein, the executive director of the non-profit Center for Medicare Advocacy, agrees. She says this new law is a good first step but does not go nearly far enough.
To that end, another bipartisan bill is under consideration in Congress. Pear of The Times again explains for us:
”Twenty-four senators and more than 120 House members are supporting bipartisan legislation to address that concern. Under that bill, time in a hospital under observation would count toward the three-day inpatient stay required for Medicare coverage of nursing home care.”
When Congress returns, we will keep an eye on how that legislation is moving forward although it would not be a surprise if it stagnates until the new Congress is sworn in next January.
TRUMP BAD NEWS
Republican nominee Donald Trump has several times said he would, as president, leave Social Security and Medicare as they are.
That is not really good enough but it is a step forward from the opponents he defeated in the primaries who all wanted to cut “entitlements,” as Republicans always do.
One morning last week, 16 August to be precise, MSNBC was droning in the background as I caught up with email.
Host Stephanie Ruhle was speaking with a former Navy Seal and current Trump surrogate, Carlie Higbie, about Trump's call for “extreme vetting” of immigrants, what the phrase means and how it would be carried out.
As Higbie explained it, our current law enforcement agencies are incapable of vetting immigrants and the country needs a commission of experts to find the kind of people who can do extreme vetting.
Here is the transcript from that point [emphasis is mine].
STEPHANIE RUHLE: Who are these people that aren't currently doing it for us?
CARL HIGBIE: What we will have to do is you have to look outside of the law enforcement agencies that we have that our hands are tied so tightly they're worried about being profiled, you know, being called a radical or any type of profile, that we need to bring people in here, intelligent people from the private sector that understand this threat and that can actually operate without the fear of bureaucracy.
SR: But, Carl, what are you gonna pay them with? Donald Trump at the same time has made it very clear he's going to reduce our debt. If you're looking to get experts from the private sector, these boys and girls get paid a lot of money.
CH: They do. But you know what? There's plenty other places to cut. If we're expanding our vetting process here, we probably can get border security somewhere else. We can probably cut a number of federal programs. I mean, heck, we give trillions of dollars away in entitlements every year. We can cut some of those.
Well, heck, why not get rid of those pesky “entitlements” - you know, Social Security and Medicare that recipients paid into all their working lives? Just dump them.
Do we think Mr. Higbie is speaking for Donald Trump? I haven't paid close attention to this idea, but do surrogates lay out policy positions that candidates' don't want to say out loud themselves?
As long as Mr. Higbie is being described publicly as a Trump surrogate, I'm going to assume he speaks for Donald Trump. What about you?
(You can watch the exchange between Ruhle and Higbie here.)