Information & Referral
By Alan M. Schlein
Last fall, Medicare officials announced that patients whose doctors expect them to stay in the hospital through two midnights or longer should be admitted as in-patients, not given observation status. This was a rules change needed to deal with an increasing number of seniors who were going into hospitals, but instead of being admitted, were placed under “observation status.”
These patients were treated like all the other admitted hospital patients, but because this status is considered outpatient care – later, when they were released from the hospital, they could not qualify for nursing home coverage, even if they were in the hospital for three days. They also faced higher out-of-pocket costs, including higher copayments and charges for drugs that are not covered for outpatient stays.
What made things worse is that many seniors in a regular hospital room didn’t know they’re in observation care because hospitals aren’t required to tell them. They only found out later when they were denied care or services.
As the federal government continues to deal with the “observation” problem, the number of Medicare observation patients has shot up 88 percent over the past six years, to 1.8 million in 2012, according to the Medicare Payment Advisory Commission, an independent agency.
But then Medicare announced a moratorium on penalizing hospitals that violate the rules. Congress has extended the moratorium through March 2015.
Now, the so-called “two midnight” rule has become even more controversial than the old system.
Making matters worse, the federal government may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing this controversial rule that tells hospitals when patients should be admitted...
By Sy Rosen
It all started with 57 cents. And although it happened ten years ago, I remember this humiliating disaster like it was yesterday. There I was standing in Carl’s Jr., looking at the bill and realizing I was undercharged. I spent about 20 seconds deciding whether I should tell the teenager behind the counter and finally came to the conclusion that for 57 cents I could take the moral high ground. However, when I informed him of his mistake, he replied with a big, helpful, pimply, toothy grin that he had given me a senior discount. I don’t know if he actually yelled this out but I felt that everybody in the place turned their heads simultaneously, even the guy in the men’s room.
The worst part was that I was afraid the grinning teenager may have been right. It’s kind of nebulous as to when you’re actually considered a senior and I didn’t really know the cut‑off. I thought I was under the wire; after all I was only 52 years old. Okay, 53, okay 54, but that’s the last okay you’ll get out of me. Okay, I was 55. But I didn’t feel like a senior or at least I didn’t up till then. I remembered the first time I was called sir and how much I hated it. Boy, I would have given anything to have that moment back.
Anyway, back to Carl’s Jr. (we old people tend to ramble); the teenager’s grin defied all laws of nature and grew even wider.