If you're looking at this title and thinking, "What the heck is this all about?" just hang in there for a quick minute - this might save you tens of thousands of dollars some day. Let me ask you a question, when you spend the night in the hospital you're considered an inpatient, right? Not necessarily. Increased pressure from Medicare is causing some hospitals to keep patients under "observation" status rather than "inpatient" status. Okay, so what's the big deal? Well, should you need skilled care after you leave the hospital it's going to be a HUGE deal!
But, you ask, doesn't Medicare cover skilled nursing care? Yes, but with a qualification. Medicare requires that you have a 3-day inpatient hospital stay prior to being admitted to the skilled nursing facility. So, if you spend four days in a hospital, but were only classified under "observation" status, your skilled nursing stay will not be covered by Medicare. And this is nothing to sniff at, as the 100 days of coverage that Medicare may have approved may cost you between $25,000 and $30,000.
Well, you may, wonder, is this common? Yes, and it is becoming more so. From 2006 to 2009 the number of observation stays increased almost 27%, and the number of observation stays that lasted more than 48 hours nearly tripled (Clark "Hospitals..."). There have even been reports of "observation" stays that lasted as long as 13 days and have even included surgery (Clark "CMS...").
So what can you do? Here are a couple of suggestions. First, be aware of your admission status. If you receive care from a hospital make sure that you ask them exactly how you are being admitted. It may effect your decision regarding the type of care you elect to receive when you leave the facility. Second, make your voice heard to your congressional representatives and to Medicare. It is Medicare, not the hospitals that are encouraging this practice. In fact, the hospital is actually on your side as they are losing money over this too. Even though they have to treat you the same way regardless of your admission status, they are reimbursed approximately 66% less if your stay is classified as an "observation" admission. To that end, here are some helpful links.
Contact your Senator: http://www.senate.gov/general/contact_information/senators_cfm.cfm
Contact your Representative: https://writerep.house.gov/writerep/welcome.shtml
Contact a Medicare Regional Office: http://www.cms.gov/regionaloffices/
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