In 2013 Medicare instituted some new rules regarding the status of patients as either in-patient or out-patient. They were so confusing that the the application of the new law was postponed a few times, most recently until October 1, 2014. Even now there are governmental committee meetings going on to 1. define the rules and 2. change the rules. Florida Senator Bill Nelson chairs the committee.
Member Sheldon Whitehouse, Senator from Rhode Island, confessed he was not sure he understood the two-midnight rule and was immediately supported by Senator Susan Collins of Maine who said she was not sure anyone understood it. I feel like I am, therefore, in good company. It is referred to as the two-midnight rule because the patient has to spend two nights in the hospital to qualify as an in-patient. However, when the clock starts running on those two nights is confusing and a person can actually be lying in a hospital bed in a hospital gown eating hospital food for days and not meet the inpatient criteria.
Medicare reports the new rules are to clarify the status of patients "in" the hospital. Previously there was a lot of hind-sighting going on and hospitals were being asked to retroactively change a patient's classification. Why did anyone care? An outpatient's bill is typically $3000 to $4000 less than that of an inpatient due to the fact that outpatient services are paid at a lower rate than inpatient. At first it seemed that this inequity had the effect of causing an increase in patient admissions but CMS (the Medicare administrator) began scrutinizing hospital admission rates and penalizing them for admitting patients unnecessarily just to get paid better. In some cases Medicare has demanded repayment of millions of dollars in what they consider over payments. In self defense the hospitals took the opposite approach and they are now often less inclined to "admit" a patient for fear of being audited.
How does this affect the patient? The patient and family may not realize there is any difference. An "outpatient" is often in a room and apparently receiving the same care as an "inpatient." The difference lays in whether they are there for observation or treatment and for how long. No one thinks to ask and wouldn't know the ramifications if they did. But observation is billed under Medicare Part B and treatment is charged under Medicare Part A. That's another big subject and there is not time to go into it here. Suffice to say, it makes a difference in what someone is going to have to pay and that someone might be you.
The greatest possible cost to the patient may come as they leave the hospital. Outpatient treatment does not qualify one for follow up nursing home care. If not covered by Medicare this can run into thousands of dollars. When added to other costs not covered, medications and co-pays for example, there can be a significant financial blow to the patient.
So step one is to ask why you are in the hospital. Are you there for observation or for treatment? This must be indicated on your admission papers and the doctor is the one who makes the determination. Make him explain his choice. If you are told you are there for observation, be sure you understand why you are not undergoing treatment, what alternatives there are, and what financial burden you are incurring as a result of this clasification. That's step two. And step three, talk with your family so everyone understands the situation.
Hopefully the Senate Committee will come up with some clarification of the new laws and perhaps force some changes or at least require full disclosure.
http://youtu.be/FGVGFfj7POA
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