Thursday, July 18, 2013

Facing the Issue: Observation Stays

When it comes to politics, it’s often easy to forget the men and women who are impacted by decisions made in Washington. But at the heart of every issue there are people – lives that are affected by laws, rules, and regulations. So we’re putting faces, names, and stories to the topic at hand. Each of these stories comes from an individual who has voluntarily chosen to become an advocate for this issue by sharing his/her own personal experience.

The Issue: Under the Medicare statute, patients must have an inpatient hospital stay of three or more consecutive days, not counting the day of discharge, in order to meet Medicare criteria for coverage of post-acute care in a SNF. As a result, although the care received by patients in observation status is indistinguishable from the care received by inpatients, outpatients in observation who need follow-up care in a SNF do not qualify for Medicare coverage. Hospital stays classified as observation, no matter how long and no matter the type or number of services provided, are considered outpatient. These hospital stays do not qualify patients for Medicare-covered care in a SNF. Read more about observation stays
here and on the AHCA/NCAL website.

This is the third post in the Facing the Issue: Observation Stays series. See previous posts here.

Paul Sabin
Ellensburg, WA

Helen Sabin never thought she would be an advocate for access to quality care. However, after her husband became ill and had to go to the hospital, their situation catapulted Helen into a more active role. On April 14, 2013, Helen’s husband, Paul, became ill and was too weak to stand up. He had an infection, and the antibiotics he was on further complicated his medical issues. Helen called the paramedics, and after consulting with the paramedics, agreed to take check him into a hospital. Paul was checked into the hospital on Sunday and left on Wednesday afternoon, per a doctor’s request to have him stay an extra day for rehab. At this point, Helen had been planning to follow the doctor’s care plan to have him receive further rehabilitation at a nursing home to complete his recovery. On Tuesday, a hospital employee came to Helen and informed her that Paul had not been admitted to the hospital, but rather was categorized as under observation – a term that Helen was hearing for the first time. Because of his time spent in observation, Medicare would not pay for the much-needed skilled nursing care center stay.

Helen is now advocating on behalf of patients, much like her husband, who need – but are denied-Medicare coverage for a skilled nursing care center stay because of observation days in a hospital. In her second letter to the editor of the Ellensburg Daily Record, Helen wrote:

“I sincerely hope that people will become aware of this and not suffer the same fate.”

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