By Susan Jaffe | Kaiser Health News & California Healthline | August 29, 2016
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]…