Terry Savage's Column in Sunday January 19, 2020 issue of the San Diego Union Tribune cautions medicare recipients about a "trick" that Medicare and the hospitals try to play on patients in order to cut costs.
Medicare.gov website tries to explain the complex rules and procedures for determination of whether a patient is "admitted" to the hospital or being "observed" at the hospital. Try reading them at the link yourself and see what you think! The way it is worded is that there are complex, but vague rules that our Doctor and hospital must use in deciding whether the patient will be admitted or observed. I've been unable to find any clear guidelines. The appeal process that is mentioned says that some aspects can be appealed, but doesn't mention the admitted/observed decision. According to the Lexology website, it appears that Medicare has not been consistent in applying the rule, and supposedly has "overpaid" for services that should not have been approved under the 3-day rule.
Apparently Medicare is considering eliminating the rule and counting the three days in the hospital whether in observation or admitted status. Nobody seems to know how much has been saved in Skilled Nursing Facility costs to the Government due to this change. Patients, Doctors, and Hospitals can game the system. For example if a hip replacement patient is ready for discharge after 2 days, they can simply keep the patient for an additional day to allow qualification for Skilled Nursing Facility Coverage. Did that save the Government money? The costs for the additional day in the hospital may be much more expensive to the Government than the several days cost at the SNF.
When my wife went to a local Scripps Hospital for major foot surgery she had to sign a bunch of forms. One form did declare that she would be in "observation status" rather than being "admitted." Of course, being our first experience like this, we didn't know the difference! We were told that the treatment in either status was exactly the same, so it appeared to not matter. As it turned out, all went well, she stayed in the hospital overnight and did not need SNF. My daughter-in-law was able to take a few days off and help me help her during the critical first few days of recovery.
What gets me is that the hospital did not explain the trade-offs on the subtle difference between observe and admitted status. The surgery was planned many months in advance, so we had time to shop for a doctor and hospital that would have given her "admitted" status. But when completing the forms on the day of scheduled surgery it seems much too late.
If Medicare is actually saving money from the 3-day rule, it is making it from those patients who are less informed, or who arrive at a hospital in an emergency state and do not have the time to make an informed decision.
Medicare.gov website tries to explain the complex rules and procedures for determination of whether a patient is "admitted" to the hospital or being "observed" at the hospital. Try reading them at the link yourself and see what you think! The way it is worded is that there are complex, but vague rules that our Doctor and hospital must use in deciding whether the patient will be admitted or observed. I've been unable to find any clear guidelines. The appeal process that is mentioned says that some aspects can be appealed, but doesn't mention the admitted/observed decision. According to the Lexology website, it appears that Medicare has not been consistent in applying the rule, and supposedly has "overpaid" for services that should not have been approved under the 3-day rule.
Apparently Medicare is considering eliminating the rule and counting the three days in the hospital whether in observation or admitted status. Nobody seems to know how much has been saved in Skilled Nursing Facility costs to the Government due to this change. Patients, Doctors, and Hospitals can game the system. For example if a hip replacement patient is ready for discharge after 2 days, they can simply keep the patient for an additional day to allow qualification for Skilled Nursing Facility Coverage. Did that save the Government money? The costs for the additional day in the hospital may be much more expensive to the Government than the several days cost at the SNF.
When my wife went to a local Scripps Hospital for major foot surgery she had to sign a bunch of forms. One form did declare that she would be in "observation status" rather than being "admitted." Of course, being our first experience like this, we didn't know the difference! We were told that the treatment in either status was exactly the same, so it appeared to not matter. As it turned out, all went well, she stayed in the hospital overnight and did not need SNF. My daughter-in-law was able to take a few days off and help me help her during the critical first few days of recovery.
What gets me is that the hospital did not explain the trade-offs on the subtle difference between observe and admitted status. The surgery was planned many months in advance, so we had time to shop for a doctor and hospital that would have given her "admitted" status. But when completing the forms on the day of scheduled surgery it seems much too late.
If Medicare is actually saving money from the 3-day rule, it is making it from those patients who are less informed, or who arrive at a hospital in an emergency state and do not have the time to make an informed decision.
