The hospital and Medicare get to decide. Not your doctor who is actually treating you.
I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.
Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.
"Medicare originally intended observation care as a way to give
doctors time to evaluate whether a patient should be admitted to the
hospital or is stable enough to go home, usually within 24 to 48 hours.
But hospitals are increasingly keeping patients in observation status
longer: 8 percent of Medicare recipients had observation stays longer
than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to
figure out how sick you are, not but diagnosing you and reading your
chart. Or, God forbid, even talking to you.
That increase may partly be a response to aggressive reviews of
hospital billing practices in recent years. Medicare contractors have
demanded refunds from hospitals that admit patients the government
believes should have been treated as observation patients or
outpatients. Medicare pays hospitals less for those patients."
And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.
"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy
in Washington, D.C., said she believes hospitals also could be trying
to avoid readmission penalties, which are assessed if too many patients
are readmitted within 30 days. Harold Engler, for example, went home
after five days, grew sicker, and then returned for another five-day
observation stay. If he had been an inpatient, he would have counted as a
readmission within 30 days."
Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:
"Dr. James Hart,
who heads a Beth Israel Deaconess committee that makes sure the
hospital follows Medicare rules, said he could not comment on Engler’s
case. But he said the hospital uses a sophisticated computer program
that tries to match patients with the correct Medicare designation based
on their illness and the intensity of hospital services required. “We
are very focused on getting the level of care accurate,’’ he said."
Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.
"Case managers generally inform patients of their status, especially if
they require skilled nursing care, he said. But that doesn’t mean
patients digest the information, at a time when they have so much to
focus on. “Part of the challenge from a patient perspective is there
really is an information overload,’’ Hart said."
You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.
I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.
Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.