You've read the stories for years. An elder is hospitalized for a few days – it could be for anything from a broken bone to chest pain, fainting, irregular heartbeat or dozens of other conditions – a common occurrence at hospitals throughout the U.S. every day.
As if an illness needing hospitalization isn't enough trouble, in thousands of cases (an estimated 2 million in 2013) when the patient is released to a nursing home for rehabilitation to build up strength, they find that Medicare does not cover the tens of thousands of dollars of that necessary treatment because they were never “admitted” to the hospital.
Instead, their stay was classified as “observation status” or outpatient and the way the rules read, no admission, no coverage for rehab.
Several readers have emailed me about the January 2014 report about this issue on NBC Nightly News. The correspondent, Kate Snow, does a good job of clearly explaining the issue. Take a look:
To ensure you or a loved one is “admitted” to the hospital is probably not at the top of anyone's agenda during an emergency. And you can be forgiven, I think, for believing you've been “admitted” if you are lying in a hospital room for two or three or more days while doctors and nurses do what they do best.
Challenging an observation classification, as reporter Snow suggests, is arduous and expensive. It requires that the patient have already paid the nursing home bill and the process is as labyrinthine as you would expect it to be.
The New York Times has a good explanation of how to proceed in this story about fighting observation status. It's not for the faint of heart.
A variety of lawsuits – individual and class action – have been slowly working their way through the legal process for several years without result but recently, thanks to such reports as the NBC video above and others, this reprehensible and cruel situation is gaining some traction.
Last Friday, Democratic Senator Sherrod Brown of Ohio introduced a bill, S.569 titled, Improving Access to Medicare Coverage Act of 2013. The text of the bill is here and the introduction reads:
”To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare.”
According to Senator Brown's website, the bill would also
”Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2013.”
The bill has 25 co-sponsors – all, as you would imagine, Democrats except for Republican Susan Collins of Maine and the two Independents, Bernie Sanders of Vermont and Angus King of Maine.
Govtrack lists the remaining co-sponsors and has more information including their prognosis that the bill has “0% chance of being enacted.”
Perhaps their pessimism is related to the fact that last March an identical bill, H.R.1179, was introduced in the House by Representative Joe Courtney, Democrat of Connecticut. It was referred to a subcommittee on health and went nowhere.
Among the dozen or so organizations that support this bill is the Center for Medicare Advocacy (CMA) which has created a page to make it easy for us to contact our Congressional representatives and urge them to end the overuse of observational status by supporting this bill.
The CMA page gives you two choices – a basic script to adapt for a personal telephone call to your representatives or submit your Zip Code and they'll supply the letter which, of course, you can edit and send along to your representatives with one click.
If you have any experience with observation status – personal or friend or family – be sure to include that in your phone call or letter.
Maybe Govtrack is right and this bill will die in committee. You can be certain that will happen if none of us speaks up to Congress.
At The Elder Storytelling Place today, Mary Hertslet: My Five Sense on Steroids