Effort to cut hospital stays compromising patient care

Unfortunately, there’s another Medicare-related issue that’s also causing financial and emotional stress for thousands of people transferring from a hospital setting to skilled nursing care. Like the co-payment situation, most often people find out about it after it’s too late.
  Federal guidelines stipulate that Medicare will pick up the tab for skilled nursing care or rehabilitation following an inpatient hospital stay. In recent years however, the Centers for Medicare and Medicaid Services (CMS) has begun to focus on reducing unnecessary hospital admissions. 
  Under that scrutiny, hospitals began screening their admissions more carefully. In cases where it was arguable whether a patient needed to be admitted, a hospital could accept the patient into the facility on “observation status.” A patient on observation status is not considered to be “admitted” to the hospital, so his or her treatment could not subject the hospital to fines or penalties for unnecessary admissions.
  Observation status was originally designed for patients who were at a hospital for 24 hours or less. Under pressure to reduce admissions, however, hospitals began keeping patients on observation status for days at a time. Generally speaking, a patient has no way of knowing whether he or she is on observation as opposed to being admitted as a patient. 
  The services received by people classified as inpatient and those classified as “under observation” is no different. So what’s the problem?  In many cases, patients do not find out until after discharge that they were never officially admitted to the hospital. At that point, they learn that many services and medications are charged at a higher rate for patients on observation. 
  Even worse, services such as skilled nursing or rehabilitation aren’t covered at all due to the lack of an “inpatient stay.” Had those patients known about the Medicare requirement upon admission to the hospital, it could have been addressed from the outset. Unfortunately, most people find out only when trying to access post acute services.
  A new Brown University study cited in the June issue of “Health Affairs” is helping to highlight the problem of declining hospital admissions in favor of longer observation stays. Researchers reviewed Medicare records of 29 million beneficiaries 65 and older in 2007, 2008 and 2009, and found that during that period, the nationwide ratio of Medicare patients who are held for observation versus those who are admitted for inpatient stays increased 34 percent. 
  In addition, observation stays grew an average of 7 percent longer during the study period while inpatient admissions dropped from 23.9 per 1,000 Medicare beneficiaries in 2007, to 22.5 per 1,000 beneficiaries in 2009. 
  Furthermore, the situation is extreme in Rhode Island, which ranked 12th in the country for increased observation stays. What can you do about this growing problem? First, be aware. Knowledge is power and knowing the questions to ask when you or a loved one is admitted to the hospital is key. Second, contact your representatives and senators. Let them know that Medicare’s goal of reducing unnecessary hospital readmissions -- though laudable -- is having unintended and costly consequences for the very people who depend on it.
 
Joan M. Woods is chair of the Rhode Island Health Care Association (RIHCA), a nonprofit association for the state’s skilled nursing facilities, and executive administrator of the Genesis HealthCare Grand Islander Center in Middletown. Contact her at (401) 849-7100 or joan.woods@genesishcc.com.