U.S. hospitals hold off admitting Medicare patients

Faced with financial penalties from Medicare if they run patients in and out too frequently, many hospitals around the country are holding off admitting many of them in the first place. Instead, they’re holding more patients for “observation” — several hundred thousand more in 2009 than two years before. Many patients are kept in the limbo ward for 72 hours or longer without being formally admitted to the hospital.

Faced with financial penalties from Medicare if they run patients in and out too frequently, many hospitals around the country are holding off admitting many of them in the first place.

Instead, they’re holding more patients for “observation” — several hundred thousand more in 2009 than two years before. Many patients are kept in the limbo ward for 72 hours or longer without being formally admitted to the hospital.

Since they’re still physically in a hospital bed, many patients and their families don’t realize that they’re considered “outpatients” and as a result are likely to face higher costs for care they get — and often no coverage for follow-up care in a nursing home.

The tactic has outraged many patients and resulted in a lawsuit by advocacy groups.

The change has come as Medicare implements tougher policies aimed at preventing frequent, repeat hospitalizations for the same medical problems, a pattern that costs the federal health system for the elderly and disabled more than US$15 billion a year.

Medicare is already auditing hospitals to see how many revolving-door patients there are for certain conditions like heart failure, heart attack and pneumonia. It will soon start imposing penalties amounting to one to three per cent of the facility’s total Medicare payment for the year if numbers aren’t held down.

Medicare policymakers intended the stick to induce hospital officials to insist on better diagnosis and care by medical staff, better coordination of care when patients go home and making sure they see outpatient doctors quickly after discharge.

But around the country, and particularly in the Midwest and South, the number of patients held for observation rose by more than 25 per cent as hospitals tried to hold down first-time admissions that might lead to readmissions, according to data reviewed by the Centers for Medicare and Medicaid Services last year and last month by researchers at Brown University.

At Brown, Zhanalian Feng, an assistant professor of health services, policy and practice and colleagues analyzed records of 29 million patients with traditional Medicare coverage between 2007 and 2009.

They found that observation stays rose to more than one million in 2009 (2.9 per 1000 beneficiaries), up from 815,000 (2.3 per 1,000) in 2007. At the same time, inpatient admissions fell to 22.5 per 1,000 patients in 2009, down from 23.9 per 1,000 in 2007. The results were published in the journal Health Affairs in early June.

There was a similar surge of observation stays in the 1990s, with many hospitals stacking patients in emergency-department halls, often for days, to get around what administrators felt were overly tight reimbursement rates for inpatient care. A new bundling system for hospital care and new rules for emergency rooms largely stopped that practice.

The more recent trend has been for hospitals to convert floors of unneeded inpatient beds to observation wards, where many tests and even treatments can move ahead without patients officially being “in” the hospital.

The practice may not be physically harming patients — observation rooms don’t look or function much differently than acute-care rooms — but collectively it’s costing Medicare patients millions of dollars in extra hospital expenses.

That’s because Medicare requires patients to have a “qualifying hospital stay” — admitted as an inpatient — before hospitalization insurance kicks in. Many patients are finding themselves short a day or more of having visits covered, something they don’t know until they get a bill. They also find themselves facing higher co-pays for services in the hospital as outpatients and without coverage for any follow-up care in skilled nursing facilities if they haven’t been in the hospital first.

The trend has outraged seniors and advocacy groups around the country, who claimed the outpatient stays were increasing and filed a class-action lawsuit to against the government last fall to stop the shifts.

Officials at the non-profit Center for Medicare Advocacy, which helped prepare the suit with the National Senior Citizens Law Center, say hospitals have been able to maneuver around vague rules for observation and typically don’t give patients written notice of their status or that they’re obligated to pay out-of-pocket for services that would be covered if they were inpatients.

Lee Bowman is a health and science writer for Scripps Howard News Service. Contact Bowman at BowmanL@shns.com

Just Posted

Crown may seek dangerous offender status for 2015 Christmas Day stabber

Psychiatric assessment being done of man sentenced In November 2017 to seven years for manslaughter

128 Flags of Remembrance now flying in Sylvan Lake until Nov. 12

Centennial Park boasts 128 Canadian flags to honour 128,000 Canadians killed and missing in action.

Fall Food Drive set for Saturday in Red Deer

Organized by the Church of Jesus Christ of Latter-day Saints

Red Deer is counting down to CFR 45

Jointly hosted by Red Deer & District Chamber of Commerce and Westerner Park

Mirror fire department still short volunteers

Fire department will close if volunteers can’t be found

Live bear cam: Let the fishing begin

Watch bears in Alaska’s Katmai National Park catch their dinner live.

Washington wants Canada to improve spill plan for U.S. spur of Trans Mountain

OLYMPIA, Wash. — Washington’s Department of Ecology wants the Canadian government to… Continue reading

National Transportation Safety Board to determine cause of Air Canada close call

Video captured the moment that an Air Canada jet flew off course… Continue reading

Edmonton public schools to review its ‘books to weed out’ list due to concerns

Edmonton Public Schools says it’s taking down its book review site after… Continue reading

Former U.S. ambassador steps up calls to get Americans to vote ahead of midterms

OTTAWA — A former U.S. ambassador to Canada is taking the battle… Continue reading

Canada aiming for the moon, and beyond, with new space technology efforts

OTTAWA — With an eye on future lunar exploration, Canada’s space agency… Continue reading

Flyers new mascot ‘Gritty’ a bearded, googly-eyed terror

PHILADELPHIA — The Philadelphia Flyers unveiled their new mascot Monday, and as… Continue reading

Tiger Woods winning adds to Ryder Cup buzz

SAINT-QUENTIN-EN-YVELINES, France — Already the most intense competition in golf, the Ryder… Continue reading

Most Read