Every Week the Center hears from beneficiaries who have been hurt by the ongoing problem of outpatient Observation Status. below are some selected stories.
Center for Medicare Advocacy client Lee Barrows testifies on "Observation Status"
TM, Maine - Refused Observation, Received No Care
My mother was evaluated in the ER for persistent lightheadedness. The MD could not find anything overtly wrong, but did suggest admission . I asked what kind of admission and he stated to the hospital. I asked observation or inpatient and he looked surprised and said observation. My mother declined. Why? , because we knew the cost was so much more, and no one warned us or cautioned us on this. How unfair! When you are living on less than $900.00 a month its criminal that Medicare beneficiaries aren’t informed until its too late. Shame on you CMS, who create these rules when you are suppose to be advocates for the beneficiaries.
DF, Maryland - 7 Days In Observation Contrary to Doctor's Orders
Physician admitted me to the hospital and the hospital reversed his decision against his will … I was not made aware of hospital observation status until after surgery, It did not make sense to me. My recovery in the hospital included on-going IVs, lab work, and no weight bearing or bending of the surgical leg. I was first put in a splint and then changed to a hinged brace for discharge to a SNF on day 7. Received some inpatient PT to learn to stand and pivot on one leg without weight bearing on surgical leg. I am 65 years old, morbidly obese, history of afib, hypertension. The physician told me prior to surgery that I would be admitted, placed in a splint for 3 days, and then put in brace. He said that I would have 12 weeks without bending the knee, but after surgery added the significant restriction of no weight bearing on surgical leg. I paid for care in rehab for six weeks until I was able to tolerate weight bearing, I have talked with the physician who adamantly disagreed with the hospital ruling. The reason given by UR was that the surgical procedure should only be done on outpatients. The physician said that the CPT codes did not adequately described what he did with a lengthy repeat procedure, insertion of mesh in the knee to help secure the repair of the soft tissue. Given the restriction of no weight bearing, I was not capable taking care of myself following surgery., And it makes no sense to me that I would be considered an outpatient observation patient for seven days in the hospital.