On second thought, I'll walk in my own shoes

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John O'Connor
John O'Connor

Chances are pretty good that you or a loved one may have spent some time in a hospital. They can be places where miracles happen.

Some of the smartest and most compassionate people on our planet can be found there, treating injuries, illnesses, diseases and more. It's a caring business.

Small surprise that many hospitals and the people who run them like to keep reminding us of that fact. Typical is an ad for Community Health Systems. “We walk in the shoes of our patients,” it proudly proclaims.

This message and others like it are pretty clear: Nothing matters more to hospitals than the wellbeing of the people they serve. Well, there may be one thing — money.

Maybe that's why you're unlikely to find any hospital commercials touting the remarkably loose ways they can define “observation status.” It's a description they like to apply with alarming frequency.

You might be under the impression that a person who spends days in a hospital hooked up to machines while receiving treatments from doctors and nurses is automatically considered an inpatient. You might also be wrong.

It's entirely possible that the hospital would view that same care recipient as an outpatient who is merely being observed.  Like many head-scratching loopholes, this one helps hospitals stay more solvent. And that's OK, except for what it can do to care recipients and their families. Namely, it may deny the latter access to Medicare Part A coverage.

As a practical matter, that usually means the end-user must pay the skilled care facility where post-op rehab care is delivered out of his or her own pocket.

Adding insult to this injury, many of the people who are on the business end of this maneuver haven't found out about the creative coding until much later, when some big-ticket, noncovered invoices started showing up.

But there are some hopeful developments concerning this wretched situation. Earlier this year, federal legislation kicked in that requires hospitals to at least let people know they are not inpatients. You can probably guess how much the people walking in your shoes helped make that happen.

About as much as they tried to assist still-pending legislation sponsored by Rep. Joe Courtney (D-CT). The bill in question would let any three days spent in a hospital meet the skilled care benefits requirement.

And it looks like those who share our shoes may soon have an additional headache to contend with. A federal judge in Connecticut recently certified a class in a lawsuit that basically calls the “observational status” maneuver a sham. That could lead to hundreds of thousands of people essentially suing the Centers for Medicare & Medicaid Services as one. Should the plaintiffs succeed in court, they would be allowed to contest previous stays where they were deemed to be outpatients.

It is somewhat remarkable that the same people who spend so many marketing dollars telling us how much they care would be acting this way. But if nothing else, they have made their top priority abundantly clear.

John O'Connor is McKnight's Editorial Director.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.