Amendment of Medicare Law

Amend Medicare Law Title XVIII

Health Care Policies

October 2014

According to the Administration for Community Living (2011), the geriatric population in the United States is estimated to be over 53 million by the year 2020. The advancement in preventative and interventional treatments is enabling our Medicare population to grow older which in turn forces healthcare workers to be faced with how to provide safe discharges to these patients. Currently, Medicare requires a qualifying three day inpatient hospital stay within 30 days of admission to a skilled nursing facility if Medicare is to cover the service. The three day inpatient requirement is preventing many Medicare patients who could greatly benefit from skilled nursing placement from qualifying for covered placement. Due to this rule, many patients are being admitted into the hospital under observation status. The admitting physician may not feel comfortable sending the patient home, may not be clear on what the patient’s condition is, or may not recognize the severity of their illness. Observation status will not qualify the patient for placement if it becomes needed.

Medicare: Observation versus inpatient

Medicare has implemented an auditing system that has increased the number of patients being admitted into observation status. “The Medicare Payment Advisory Commission reported a 70% increase in observation stays exceeding 48 hours between 2006 and 2008 (Kolanowski & Edelman, 2012, p.3). The patient that is placed into observation status is receiving the same care and treatment as one in inpatient status, but will not qualify for skilled nursing placement if they were to need it. This is very disheartening and sad. The Medicare patient faces huge financial consequences with this status issue. Medicare Part B will generate a separate bill for each service provided leading to a large copayment that could exceed what an inpatient deductible would have been for the same stay under a different...