Hospital lobby, the ball is back in your court
James M. Berklan
If you've ever been involved with salary negotiations, you might have some idea of what's going on among Medicare officials, long-term care advocates and hospital lobbyists. It would be kind of amusing if it weren't so painful for so many.
On Tuesday, Rep. Jim Renacci (R-OH) essentially volleyed the ball back over the net on behalf of long-term care operators and numerous others. He introduced the “Creating Access to Rehabilitation for Ever Senior (CARES) Act of 2013. LTC lobbyists have sung its hosannas already. I'd hazard a guess that patient-rights advocate AARP, which said it is studying the bill, will eventually come out in favor of it. It previously endorsed the Improving Access to Medicare Coverage Act (H.R. 1179/S. 569), which would count time spent in observation toward the three-day stay inpatient hospital stay requirement for Medicare coverage of SNF care.In a nutshell, Renacci's bill it would allow nursing centers that meet certain quality measures and ratings to be able to assume the care rights — and lofty Medicare reimbursements — for hospital patients before the current three-day minimum inpatient stay is met. LTC operators chafe enough at the out-of-date three-day requirement. Hospitals' recent expanded use of “observation stay” designations has choked patient flow and made it worse. Hospitals' use of observation-stay designations “skyrocketed” more than 100% in a recent eight-year period, AARP researchers announced within the past week.
The CARES Act is notable because it doesn't call for outright elimination of the three-day rule. LTC providers would still have to show their value to get the rule eased for themselves and their prospective residents.
This is the latest lob back at the hospital crew, which understandably is reluctant to see a cash cow walk out the door any sooner than it has to.
Just a week ago physicians and hospital interests released a statement calling for delay of the “two-midnight rule,” which went into effect Oct. 1. That rule says that patients staying longer than two midnights' duration in a hospital would have to be declared inpatients. This would give individuals a big jump toward satisfying the three-day inpatient requirement that earns them Medicare coverage at a nursing facility.
The two-midnight rule is a reaction to hospitals' keeping patients for as long as a week and still designating them “observation” status. Docs and hospitals complain the rule ignores clinical realities and shouldn't force them into designating inpatient or outpatient status based only on time-related criteria.
Tuesday's bill is actually just the latest in a string. Over the summer, Rep. Jim McDermott (D-WA) introduced the “Fairness for Beneficiaries Act of 2013,” which called for eliminating the three-day requirement.
Also in play, of course, is the aforementioned "Improving Access to Medicare Coverage Act of 2013,” which which was proposed by two Democrats and a Republican.
Of course, pre-dating these offerings were earlier proposals favoring hospitals' self-interests. And back-and-forth they go. And will continue to go.
Keep your eyes peeled for the ball to reverse direction soon again, when hospital interests defend their “right” to keep patients longer — and, correspondingly, out of rehab facility beds longer.