Observation Status

The rate of heart-failure patients who wind up admitted to the hospital again soon after leaving has dropped significantly, as well as the readmission rate for patients treated for pneumonia and other serious conditions. This is a triumph of the Affordable Care Act according to the Obama administration, because hospitals with too many readmissions within 30 days of an inpatient stay are penalized. Of course, the goal is to keep patients out of the hospital by keeping them healthier due to better follow-up treatment, thus lowering the cost to the government. However, patients are re-entering hospitals under “observation status” which keeps them out of the readmission count. Under observation status a patient can remain in the hospital for days and receive the same care as an inpatient. Under Medicare billing rules though, the stays are considered outpatient visits and do not trigger penalties under the health law. Medicare billing data shows that observation stays can skew readmission numbers so hospitals avoid penalties even if patients continue to have complications and return for repeat visits. These stays are cheaper for the government but sometimes lead to big bills that are the responsibility of the patient. Medicare admits to recognizing some problems with observation stays and has revised some policies. Initially the program included patients with heart failure, heart attacks and pneumonia but now includes chronic obstructive pulmonary disease (COPD), some joint replacements and the prediction of additional covered diagnoses. Bottom line: just because a patient is in a hospital bed doesn’t mean the person was admitted to the facility. For additional information go to: http://www.msn.com/en-us/money/healthcare/medicare-rules-reshape-hospital-admissions/ar-AAfV8z1?li=BBnb7Kv