Wednesday, July 30, 2014

Brad Flansbaum offers this interesting post about the ambiguities and uncertainties inherent in the current Medicare "two-midnight rule."  He refers to a recent white paper prepared by a group of hospitalists:

Months of work have led us to our white paper, entitled, The Observation Status Problem: Impact and Recommendations for Change. The release utilizes a multidimensional data set of significant size and includes a finding synthesis.  It is our hope to use the information we collected to inform Congress, CMS, media, and members on the somewhat chaotic understanding of observation status policy. 

This is well done and thoughtful and could be of assistance to federal policy makers, if they take the time to read and listen.  Look at this portion of the introduction:

The intricacies of observation policy have created a situation where observation care is now commonly being delivered on hospital wards, indistinguishable from inpatient care. The frequency and duration of observation status has also grown significantly in recent years, well beyond its original intent. This is important because observation is not covered by Medicare Part A hospital insurance, and patients under observation are ineligible for skilled nursing facility (SNF) coverage at discharge, which may leave them vulnerable to additional complications.

The results:

--Lack of knowledge and confidence in implementing the two-midnight rule
--Disruptions to hospitalist and hospital workflow
--Decrease in the ability of hospitalists to make independent clinical decisions
--Negative impacts on patients, including access to SNF coverage and highly variable financial liabilities 
--Damage to the physician-patient relationship


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