Observation Status—A Name at What Cost?

[摘要] There has been considerable attention in the lay media regarding the “unfairness” and the financial burden placed on Medicare beneficiaries admitted by hospitals under an observation status. As a result, legal and public challenges1,2 to the Centers for Medicare and Medicaid’s (CMS) observation rule have been filed to reduce patients’ financial liability when driven solely by the “status” assigned to their hospitalization. Partly because of this outpouring of patient-driven criticism, the CMS amended the previous observation admission rules. On October 1, 2013, the CMS implemented the “Two Midnight Rule”3 to reduce the growing number of observation hospitalizations extending beyond 48 hours (between 2009 and 2011, the number of patients in observation beyond 72 hours increased by 88%)4 and to lessen Medicare patients’ financial burden due to hospitals’ uncertainty surrounding level of care designations. For hospitals treating a majority of Medicaid patients, it would appear harder to quantify the financial impact to enrollees or to the health care system of the current observation system. Medicaid enrollees (especially children) are frequently not required to pay deductibles or copayments for emergency or hospital-based services. The designation of an enrollee’s stay as observation or inpatient would appear to be cost-neutral to patients and to the health care system, but that is an incorrect assumption. Large quantifiable administrative and compliance costs exist from the current federal and state observation regulations that impact our health care system. The risk of not assigning the correct admission status to a patient’s hospitalization is significant and has resulted in legal and financial penalties for hospitals and doctors. In the case of Medicaid and managed Medicaid patients, regulatory …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob