Angela Cole Westhoff is president and CEO of the Maine Health Care Association.<\/p>\n
When Medicare was created in 1965, it wisely recognized that older adults often need skilled nursing care after hospitalization. That\u2019s why Medicare requires the patient to spend at least three days in a hospital before covering the subsequent care in a skilled nursing facility. It\u2019s a straightforward policy designed to ensure patients get the care they need during their recovery and it has worked well for nearly six decades.<\/p>\n
But today, that system is being undermined by a loophole that results in patients and families having to choose between paying out of pocket for needed medical care or going without care.<\/p>\n
The problem is \u201cobservation status.\u201d Increasingly, hospitals are classifying patients as \u201cobservation status\u201d rather than \u201cinpatient,\u201d even when patients deemed on \u201cobservation\u201d spend three or more days in the hospital receiving the same level of care as inpatients. <\/p>\n
Under current Medicare rules, a patient who is labeled as observation status will not have their days in hospital count toward the three-day requirement. As a result, a patient can spend four, five or even six days in a hospital under observation, receive intensive medical care and still find themselves unable to access Medicare-covered care in a nursing facility after they are released from the hospital.<\/p>\n
The consequence? It forces older adults to decide between medical debt or skilled nursing care as part of a medically indicated recovery plan.\u00a0<\/p>\n
This problem is happening to older adults in Maine right now. A patient who spends five days in a hospital receiving IV therapy, wound care and cardiac monitoring under observation status doesn\u2019t qualify for Medicare coverage at a skilled nursing facility, even though they need that level of care. They either stay in an expensive hospital bed longer than necessary, potentially in a bed that could be used for another individual in need, or they attempt to go home without the professional, skilled support their condition requires.<\/p>\n