AARP has released a report titled “Rapid Growth in Medicare Hospital Observation Services: What's Going On?” The report finds dramatic increase in the use of Medicare observation status for Medicare beneficiaries between 2001 and 2009. The findings raise concerns about the clinical benefit of long-term observation and the high out-of-pocket costs to patients. AARP endorses the legislation, Improving Access to Medicare Coverage Act of 2013 (H.R. 1179/S. 569), introduced in the House and the Senate by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), and Sens. Sherrod Brown (D-OH) and Susan Collins (R-ME), that would count the time spent in observation…
Medicare is currently undergoing its second round in the penalty program. The campaign works toward reducing the numbers of patients readmitted within a month and hospitals will have their reimbursements reduced for poor performance. The majority of hospitals with high readmission rates serve low-income patients. Kaiser Health News discovered that 1,371 hospitals are receiving a lower fine than before. Learn more in the Washington Post.
Many Medicare patients who require skilled nursing care after a hospital stay are often surprised when they receive a very expensive bill for the skilled nursing care. Medicare beneficiaries can be held as “observation” rather than as an admitted patient even though it may appear to the patient to be a regular stay in the hospital. Medicare will not pay for the subsequent skilled nursing care if the patient’s hospital stay is classified as observation. Learn more. A new investigation shows that whether a Medicare patient is admitted to the hospital or kept for observation depends on what hospital they…
Although it’s still early, this policy seems to have had an effect. A recent New York Times article outlined the efforts of hospitals across the country that have seen success in reducing hospital readmissions by adopting changes to discharge planning including: Identifying patients who are at highest risk of readmission Follow-up nurse visits to patients’ homes Proactively ordering patient prescriptions and scheduling follow-ups Patient and caregiver education Culturally specific diet tips Transportation to for patient follow-up appointments Increased monitoring of nursing home patients Of these efforts, patient education is one the most important. Taking prescribed medicine properly is essential to…
If you are on Medicare and spend 3 days (midnights) admitted to a hospital, you will qualify for rehabilitation in a nursing home. Consequently, Medicare will pay the first twenty days, and you will be in a co-pay with Medicare up to 100 days. However, the trend is, hospitals are under significant pressure from Medicare to fully treat a person once they are “admitted” to the hospital. There are guidelines that the hospital has to meet basically to ensure that person stays healthy once they are dismissed from the hospital. Therefore, hospitals are bringing a person in for “observation” for…
With more than 1.6 million Americans now living in nursing homes, many of us are all too familiar with the debilitating cycle of a nursing home admission followed by repeated hospitalizations, a spiraling into decline, and ultimately death. A Brown University study published in The New England Journal of Medicine, confirms what many of us have observed: health care transitions, such as moves in and out of the hospital from a nursing home, do not lead to positive outcomes. More common are frequent medical errors; poor care coordination, infections and additional medications. For patients with acute dementia, these transitions can…
To receive up to 100 days of rehabilitative treatment either in a rehab facility, nursing home, or at home, generally, you need at least 3 days inpatient hospitalization. Consequently, if you are in the hospital for two days or less, you may not qualify for this Medicare benefit and will pay privately. When calculating three days of inpatient care, consider three “midnights” and make certain the time was spent as an inpatient and not in the emergency room or “under observation.” Although, in the hospital, sleeping over, and if you’re not “admitted” you are not considered eligible. If “under observation”…
As we and our loved ones age, we put a lot of effort (and resources) into making sure a hospital bed is available when needed. New research shows that while that hospital bed may sometimes be necessary, getting up and out of it as quickly as possible is key to recovery. As it turns out, the hospital bed is a huge contributor to old-age infirmity, as studies prove that bed-rest and immobility slow healing and stunt recuperation. A recent New York Times column, “The New Old Age” covered the results of a study conducted by University of Texas physician, Dr….
Home health agencies, hospitals and consumer groups are complaining that a new rule intended to curb unnecessary Medicare spending will make it harder for senior citizens to get home care services. Under the requirement, which is to take effect Friday, Medicare beneficiaries will have to see doctors 90 days before or 30 days after starting home health services in order for the home health agencies to be reimbursed. Those face-to-face visits may be a burden for some home-bound frail seniors, as well as those who live in rural areas, the industry says. Under current law, doctors must prescribe home health…
The Kaiser Family Foundation Report explores factors that appear to drive relatively high rates of hospitalizations, based on interviews with doctors, nursing home staff and families in four cities. Key factors include liability concerns, limited onsite staff capabilities, difficulty reaching residents' physicians for care instructions on nights and weekends, better and more timely access to diagnostic tests in hospitals, and patient preferences. Physicians with patients in a long-term care facility say it is more convenient and potentially in their financial interest to see patients in the hospital, based on their understanding of coverage and payment policy.
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