GREENVILLE — The Centers for Medicare and Medicaid Services (CMS) recently revised its Medicare hospital Inpatient or Outpatient report.
CMS recommends that patients using Medicare health benefits and entering the hospital to find out if they are considered an “inpatient” or “outpatient” when sick and needing hospital care that could lead to extended care.
Yet the NRLN (National Retiree Legislative Network) states on its website that one federal house resolution 3531 currently being reviewed eliminates the three-day, in-patient requirement before getting into a skilled nursing facility to save Medicare hospital costs.
“There are three bills in congressional committees that address the three-day hospital stay requirement for Medicare beneficiaries to be eligible to receive SNF (skilled nursing facility) services,” according to a letter to the Greenville Daily Advocate by Marcia Eyler of Laura. The other two legislative items are a house resolution and senate bill that could change the observation time to the in-patient hospital stay.
President and Chief Executive Officer of Wayne HealthCare in Greenville Wayne Deschambeau refers to the Medicare three-day requirement stay as the “72-hour rule.” The rule has been around for a while, and he thinks that any requirement are related to reducing costs of patient care and not what the patient needs. Observation status in the hospital costs less than in-patient status, too, he stated.
“I have never seen or heard a good clinical argument for the 72-hour rule,” Deschambeau said. “If the goal is to provide patient care, at an appropriate level, then all care levels should be available to the patient, regardless of where they started the care process. As you know, no one says you cannot have nursing home care if you do not meet the 72-hour inpatient rule. It only says Medicare will pay nothing.”
The federal agency managing Medicare and Medicaid, CMS, has experimented with a 48-hour rule that Deschambeau also thinks has no clinical basis like regard to patient care.
“A significant number of patients, that stay overnight, are called “observation patients” and are not in-patients. This used to be limited to stays of less than 24 hours. As of now, you may stay for a number of days and nights as an observation patient. You do not qualify for in-patient status, even if you are sick enough to be in a hospital bed, unless you meet certain clinical rules.
“The observation status, by the way, is paid at a rate substantially below that of inpatient status,” he stated, noting that the three methods currently address reducing payments and are not related to patient care.
So what are the rights of the individual? According to the CMS, Medicare Part A covers in-patient hospital services. Medicare B covers most of doctor services for in-patients. Part B covers out-patient hospital services and most of those related doctor services. While self-administered drugs are covered under Medicare Part D, drugs related to being in a hospital have their own requirements and are usually paid for by the patient, who may be able to get them reimbursed through Medicare D.
To protect individual’s rights, CMS recommends that Medicare recipients get their questions answered; learn about treatment choices and decisions; and get a review of decisions about health care payment, services and prescription drug coverage.