Specialized hospital units for patients under observation status could dramatically reduce the number of seniors forced to pay out-of-pocket for skilled nursing care, according to findings in the current issue of Health Affairs.
When you complain about bizarre government conditions or regulations, as columnists are wont to do, you usually have to assume you’re just whispering into a stiff wind. But now comes word that no less than the Office of Inspector General of your Department of Health and Human Services is jumping on the bandwagon to change the hospital “observation stay” madness.
The former head of the Centers for Medicare & Medicaid Services has said the agency should scrap a rule requiring three days as a hospital inpatient to qualify for Medicare coverage of skilled nursing care. Long-term care advocates praised the statement.
Government lawyers and opponents of Medicare’s “observation stay loophole” recently squared off in federal court, when a judge convened the first hearing in the Bagnall vs. Sebelius case. Richard Bagnall and other seniors denied Medicare coverage for skilled nursing care brought the case in 2011.
While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare Part B patients have become more medically complex than just a few years ago?
Bully for provider groups pulling out the stops to draw attention to the ludicrous mishandling of “observation stay” designations by many hospitals. One prong of the plan is to have providers supply anecdotes about individuals hurt financially and emotionally by the practice.