By Steven Buttice, Founder and President, Living By Your Design, Inc.
Health care transformation continues. There are more out-of-pocket costs for patients and there is more pressure on hospitals to perform efficiently and effectively. Hospitals must provide patient-centered care and Medicare-approved care. One example of this balance is the hospital’s effort to correctly identify patient status. If you stay overnight or longer in the hospital, you may still be regarded as an outpatient. Observation status means you have not been admitted as an inpatient and Medicare outpatient benefits pay for your care. An inpatient hospital admission is a complex medical decision based on the doctor’s judgment and the need for medically necessary hospital care. Medicare can determine in an audit that a patient was unnecessarily admitted as inpatient when they should have stayed as an observation patient. Hospitals work to correctly define patients because their reimbursement depends on it.
Inpatient or outpatient status is not something you can choose as a family member, but you want to keep asking questions and be informed about your parent’s situation. It will help you be prepared for subsequent medical bills, and to better understand future care costs and needs. It is important to note that if skilled nursing is a possibility, it is covered under Medicare only after at least a 3-day inpatient stay.
Case Study
Dad was at a meeting where the two types of admissions were discussed at length. A person at the meeting had chest pains and went to the hospital through the emergency room. He has a number of other health conditions and was kept for several days. He was released to home and was surprised to receive a $563.00 bill. What was the bill for when he has original Medicare and a plan F supplement? He found out the bill was for his drugs in the hospital. They were not covered under his hospital benefits since he was considered an outpatient. Medicare viewed his drugs (that he usually takes at home) as take home drugs and not covered. These same drugs would have been covered under an inpatient stay.
What Questions Should I Ask?
When your parent is moved to a hospital room, ask if they are an inpatient admit. Ask what criteria should be met for an inpatient stay. If your parent’s condition changes, ask again about inpatient status. After your parent is discharged, status cannot be changed.
Staying on Top of It All
Helping Mom and Dad while caring for your own needs, your spouse’s needs, and your children’s needs is not easy. It is very helpful to discuss and plan for reasonable events. Your role as the sandwich generation is to guide your parents while being careful not to take away their control or their confidence. Start talking and making suggestions early, and keep the conversation going. Do not wait for a crisis.
If you would like a list of “Questions to Ask in Different Aspects of Care,” visit the website LivingByYourDesignInc.com. For more information, contact Living By Your Design, Inc. We focus on the issues of older Americans: legal, financial, free guidance for residential placement and health care issues. Call 309-285-8088. We are located at 809 W. Detweiller Dr., Peoria, IL 61615.