Hospitals Caught Between a Rock and a Hard Place Over 'Observation'

Cheryl Clark, for HealthLeaders Media , September 15, 2010

Observation was supposed to be limited to 24 or 48 hours, so clearly many hospitals want to keep the patients close by in the belief that they may be too sick to go home, but too healthy to qualify for a RAC-free admission.

Tarasovitch says that between 2008 and 2009, ISJ's observation days "have risen considerably. We have to do the right thing for the right reason," he says.

But still, the complaints from family members have risen as well. There have been three so far this year from families with concerns such as those expressed by Lubrant, who've been saddled with bills they didn't think they deserved, and certainly didn't expect, he says.

"Their frustration levels are getting higher and higher," he says, "and we're caught in the middle."

Nationally, the complaints are rolling in to Toby Edelman, an attorney with the Center for Medicare Advocacy in Washington, D.C. Every day, it seems, she gets yet at least one more complaint from a weeping family members over bills they never thought they'd have to pay because Medicare would always be there.

"The cases don't seem to stop," Edelman says.  She adds that at long last, there's one issue on which hospital officials, advocates, and skilled nursing homes agree with family members and patients.  There has to be a way to put a limit on the number of days a patient can stay in the hospital, after which the patient must be admitted, so follow up care won't break the family bank, and hospitals can be paid for the quality care they deliver, she says.

From Sandi Lubrant's perspective, the situation has been a nightmare not just for her, but for her father who recently suffered a stroke.

The last time her mother was taken to the hospital just a week ago, "she had fallen after dinner while throwing bread crumbs to the birds, and hit her head on the door jamb and then the floor, resulting in a goose egg-sized knot on her forehead and concussion."

1 | 2 | 3 | 4

Comments are moderated. Please be patient.

11 comments on "Hospitals Caught Between a Rock and a Hard Place Over 'Observation'"

Priscilla T. Bassett (2/8/2012 at 6:01 PM)
a fair presentation of the hospital side

Kay F. (9/21/2010 at 11:45 PM)
I know Medicare expects the beneficiary to ask a hospital whether they are inpatient or observation. Medicare even publishes a brochure explaining the difference. But also according to Medicare if she was admitted as Inpatient and then changed to observation then it was then this hospitals responsibility to notify her of the change. Did it really take 5 days for them to notify her? And why would a hospital keep a patient past 48 hours if they are not sick enough to be an "inpatient"? It seems like a real financial loss for the hosptial.

sobrien (9/21/2010 at 5:04 PM)
When a physician makes the decision to keep a patient in the hospital, one of the first decisions he/she must make (usually with the guidance of a Utilization Review Nurse) is whether the patient should be admitted as an 'Inpatient', or made 'Observation'. The criteria that is used to guide this decision is spelled out in the InterQual or Millimen criteria. With each years update in the criteria guidelines, Inpatient criteria has become increasingly harder to meet. The new criteria, which became active as of August 1st, makes it especially difficult to justify an 'Inpatient' admission. The patients aren't any less sick, but the criteria points us toward an 'Observation' stay. Though CMS guidelines recognize that the decision to admit a patient is a "complex medical decision", the hospital is at risk of being denied payment if the patient is admitted to 'Inpatient', yet does not clearly meet this criteria. The changes this year will likely show an even bigger jump in the use of 'Observation' stays, with the resulting burden begin placed on both the hospitals, as well as the patients and their families.




FREE e-Newsletters Join the Council Subscribe to HL magazine


100 Winners Circle Suite 300
Brentwood, TN 37027


About | Advertise | Terms of Use | Privacy Policy | Reprints/Permissions | Contact
© HealthLeaders Media 2014 a division of BLR All rights reserved.