Tag: California Hospital Association

By Law, Hospitals Now Must Tell Medicare Patients When Care Is ‘Observation’ Only

By Susan Jaffe | KAISER  HEALTH  NEWS | March 13, 2017 |This story also ran in usat 4sidebar

Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got

Hospitals must complete this notice and give it to Medicare observation patients.

surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care.

The notice may cushion the shock but probably not settle the issue.

When patients are too sick to go home but not sick enough to be admitted, observation care gives doctors time to figure out what’s wrong. It is considered an outpatient service, like a doctor’s visit. Unless their care falls under a new Medicare bundled-payment category, observation patients pay a share of the cost of each test, treatment or other services.  And if they need nursing home care to recover their strength, Medicare won’t pay for it because that coverage requires a prior hospital admission of at least three consecutive days.

Observation time doesn’t count.

“Letting you know would help, that’s for sure,” said Suzanne Mitchell, of Walnut Creek, Calif. When her 94-year-old husband fell and was taken to a hospital last September, she was told he would be admitted. It was only after seven days of hospitalization that she learned he had been an observation patient. He was due to leave the next day and enter a nursing home, which Medicare would not cover. She still doesn’t know why.

“If I had known [he was in observation care], I would have been on it like a tiger because I knew the consequences

This KHN article also ran in The Philadelphia Inquirer.

by then, and I would have done everything I could to insist that they change that outpatient/inpatient,” said Mitchell, a retired respiratory therapist. “I have never, to this day, been able to have anybody give me the written policy the hospital goes by to decide.” Her husband was hospitalized two more times and died in December. His nursing home sent a bill for nearly $7,000 that she has not yet paid.  [Continued at Kaiser Health News and USA Today] …

US health-care groups voice concerns about replacing ACA

lancet cover 2Volume 389, Number  10071 

25  February 2017 

WORLD REPORT    Few details have emerged regarding a replacement for the US health law.  Susan Jaffe, The Lancet’s Washington correspondent, speaks to stakeholders about the problems they foresee. 

Less than 8 hours after Donald Trump took the oath of office as the 45th President of the USA, he signed an executive order reiterating a popular campaign promise: “It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act [ACA].”

Californians march against the repeal and replacement of the ACA, Feb 4, 2017 / Getty Images

Yet 5 weeks later, the Trump Administration and the Republican controlled Congress cannot agree on whether to repeal and replace it simultaneously—as the president desires—and what the replacement will be. Tom Price, Trump’s new Health and Human Services Secretary, assured senators during his nomination hearing last month that “nobody’s interested in pulling the rug out from under anybody. We believe that it’s absolutely imperative that individuals that have health coverage be able to keep health coverage…”

…The ACA’s uncertain future has rattled health insurers—initial 2018 policies are due as soon as April—and rippled through the health-care system to worried providers and patients. “Like everyone else, we are waiting for more information to be released by the Administration and Congress”, said Jan Emerson-Shea, a spokeswoman for the California Hospital Association, a state with more than 1·5 million patients enrolled in ACA insurance plans.  [Continued here] …

Protecting California’s Seniors From Surprise Hospital, Nursing Home Bills

By Susan Jaffe  | Kaiser Health News & California Healthline | August 29, 2016CA Healthline logo-chl

Californians with Medicare coverage would no longer be surprised by huge medical bills stemming from “observation care” in hospitals under legislation that state lawmakers approved overwhelmingly last week and sent to Gov. Jerry Brown to sign into law.

The sticker-shock can happen when people go to the hospital but health care providers are not sure what’s wrong. If the patient is not sick enough to be formally admitted, but still not healthy enough to go home, they can stay in the hospital for “observation care,” which Medicare considers an outpatient service. That can mean higher out-of-pocket expenses for the patient….And because observation patients have not spent the required minimum of three straight days as an admitted patient, Medicare will not cover their follow-up nursing home expenses after discharge. Observation care doesn’t count….“I don’t think the average person knows the difference,” said Sen. Ed Hernandez (D-West Covina). Hernandez introduced the legislation requiring hospitals starting Jan. 1 to tell all patients if they are getting observation care.

…The legislation also would require the nation’s first minimum nurse-to-patient staffing ratios in observation care units for hospitals that have separate units for those patients. “We are still the only state that has these very specific mandated ratios for every unit of the hospital that have to be adhered to every minute of every day,” said Jan Emerson-Shea, a spokeswoman for the California Hospital Association, which represents 400 hospitals. Those staffing rules, however, excluded observation care units.

“We wanted to make sure hospitals didn’t use observation care as a loophole to avoid any of the minimum nursing staffing requirements,” said Sen. Hernandez. [Continued in California Healthline or San Jose Mercury News]…