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The NSPA Blog

The Biggest Mess in Healthcare Today

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Posted on December 21st, 2015 by Teri Dreher, under Observation Status, Something New

Not a week goes by that I don’t hear stories from seniors, those who care for seniors, and even healthcare providers who are fed up with the “scam” of the inpatient vs. observation status controversy.
 
This major rule that is part of the Affordable Care Act is costing seniors billions of dollars annually as they get stuck with bills for stays in rehab facilities that are not covered; they were never actually an inpatient in the hospital that originally treated them and decided they were too weak to go directly home. The patient is flabbergasted because they thought they were admitted—they slept in the same bed that they would have if they were fully admitted, but they were actually “admitted” under observation status, which cancels their qualification for rehab benefits by Medicare.
 
Emergency room doctors are under heavy pressure to admit every senior they can as an observation patient. This is a nice way of saying, “We are concerned about you and think you need close watching, so we are going to keep an eye on you to make sure you are well enough to go home.” In reality, the patient’s bill is higher because many items are not covered under Medicare Part B, which pays for observation or outpatient-type stays. And if the patient goes home after an inpatient admission and returns within 30 days, the hospital is in no hot water from Medicare because they were never technically “admitted” in the first place. Rehab will only be paid for by Medicare if the patient was a full admission for at least 3 midnights. 

With over 36 years of clinical experience in Critical Care nursing, home based health care and expertise as a cardiovascular nurse clinician, Teri is well acquainted with the complexities of the modern healthcare system. She has served as a nursing leader, mentor, educator, and consistent patient advocate throughout her career in some of the best hospitals across the country. Her passion to keep the patient at the center of the model of nursing care led her to incorporate NShore Patient Advocates, LLC in 2011, serving clients throughout the northern suburbs of Chicago.

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