Bill seeks to restrict hospital ‘observation’ stays

March 04 01:00 2015 by ushadmin

The California Nurses Association is backing another legislative attempt to tackle the controversial issue of hospital “observation” stays. A similar bill died in committee last year.

Senate Bill 483 by Jim Beall, D-San Jose, seeks notification requirements and restrictions on observation stays in acute-care hospitals. These short stays typically start in the emergency room and may involve what looks like hospital admission, but are ultimately considered outpatient care by the Medicare program. This means patients pick up a bigger share of the tab — and many have no idea this will happen.

If short stays are considered outpatient care by federal health authorities, the problem hits hospitals, too. They have to pay back the extra money — sometimes years after the fact. Medicare is cracking down on hospitals that admit patients when it is not medically necessary for them to be there.

The stakes are huge. In 2012, Medicare identified $14.3 billion in improper hospital payments. Hospitals have reacted by putting patients on observation while they decide if they can be safely treated and sent home instead of being admitted.

There’s other fallout for patients besides a big hospital bill. Medicare requires a three-day hospital admission before the program will pay for long-term care.
Observation stays don’t count, so patients can get hit with a big nursing-home bill, too.

“Many of these patients are extremely sick,” CNA co-president Zenei Cortez said in a news release. “Many have serious symptoms such as chest pain and cardiac complaints, and when discharged will likely return with the same symptoms or medical problem. Yet the hospital is not fined by Medicare because the patient was never formally admitted.”