Hospitals not necessarily to blame

As an experienced nurse and case manager, I read with interest your front page article regarding hospital observation status. I also read the related Nov. 26 editorial. I felt that in both cases it was implied that hospitals were at fault and the cause of this confusion.

The purpose of observation status is for the doctor to decide if a patient should be admitted to the hospital or discharged. In the emergency room, it is sometimes difficult to make this decision. Observation status allows a doctor more time to make this complex decision.

There are financial implications to this medical decision. Inpatient hospitalization is billed to Medicare Part A. Observation status is billed to Medicare Part B, and patients are responsible for 20 percent of the charges. Most often their medical supplement covers this part of the bill. Deductibles for Medicare A and Medicare B also differ. The Medicare trust fund is saving money when a patient is admitted to an observation bed.

I don't believe hospitals are deliberately admitting patients to an observation bed to avoid a Medicare audit. However, your article and editorial did not point out that hospitals will not be paid if Medicare determines that the patient should have been in an observation bed.

Medicare regulations regarding observation status have caused countless discussions, payment confusion and dissatisfied doctors and patients. Hospitals are doing the best they can to provide quality care under Medicare guidelines.

Each year at this time Medicare sends its annual publication, “Medicare and You” to eligible Medicare recipients. It contains a section that describes observation status. Seniors should read this to understand what it means to be placed in an observation bed while hospitalized.

Hospitals staff are required to follow Medicare guidelines. Most of us would support House Bill 5950, which would decrease confusion, paperwork and unhappy patients.

Kathy Rous

Roselle