Hospital Observation Care Can Be Costly For Medicare Patients

http://khn.org/news/observation-care-faq/

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http://khn.org/news/hospital-surprise-medicares-observation-care/

Some seniors think Medicare made a mistake.  Others are stunned when they find out that being in a hospital even for a couple of days doesn’t always mean they were actually admitted.

Instead, they received observation care, considered by Medicare to be an outpatient service. The observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits. Yet, a government investigation found that observation patients often have the same health problems as those who are admitted.

Medicare officials are working to finalize a notice that will inform patients that they are receiving observation care. That is required under a federal law that went into effect in August, and hospitals will likely begin using the notices in January. Some states already require that patients be told about their status.

More Medicare beneficiaries are entering hospitals as observation patients every year. The number doubled since 2006 to nearly 1.9 million in 2014, according to figures from the Centers for Medicare & Medicaid Services. At the same time, enrollment in traditional Medicare grew by 5 percent.

Here are some common questions and answers about observation care and the coverage gap that can result. (Seniors enrolled in Medicare Advantage should ask their plans about their observation care rules since they can vary.)

‘America’s Other Drug Problem’: Copious Prescriptions For Hospitalized Elderly

http://khn.org/news/americas-other-drug-problem-copious-prescriptions-for-hospitalized-elderly/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33586061&_hsenc=p2ANqtz–bdRi0dTgQHu8uQ2ZulMR4yf3sqzJr1Sth8fzdGhdBCCWQUjWv6mmzHR3SYxmWe2x3oTFceHM_ETsw6MSh6jG6n9qT_Q&_hsmi=33586061

Harriet Diamond at the UCLA Medical Center in Santa Monica, California, on Thursday, May 5, 2016. (Heidi de Marco/KHN)

An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.

“This is America’s other drug problem — polypharmacy,” said Dr. Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica. “And the problem is huge.”

CBO: Aging population, drugs driving federal healthcare spending

http://www.healthcaredive.com/news/cbo-aging-population-drugs-driving-federal-healthcare-spending/425062/

The country’s aging population, which is using more Social Security and requiring more Medicare coverage, is driving most of the spending increases, according to the report. Compared to 50 years ago, the number of people who are 65 years old and older has more than doubled, CBO found. As a result, Medicare outlays will remain at about 3% of GDP until 2018 but then increase on an annual basis through 2026.

“Over the next decade, as members of the baby-boom generation age and as life expectancy continues to increase, that number is expected to rise by more than one-third, boosting the number of beneficiaries of those programs,” the report states, adding, “As a result, projected spending for people age 65 or older in three large programs — Social Security, Medicare, and Medicaid — increases from roughly one-third of all federal noninterest spending in 2016 to about 40% in 2026.”

Fewer than one-third of ACOs qualify for Medicare bonuses

http://www.fiercehealthcare.com/payer/cms-acos-generated-466m-savings-2015?mkt_tok=eyJpIjoiTXpNd1lqZGlNR0U1WkRJeCIsInQiOiJLOWhzWGhXZ2FrUHdBMEg5d1VNTnppNTR6TEh5XC9tQjI1bDgxcVlUUWNcL1wvSWt0SkRUck9vYm90K1VuSlZJUGFpQ3RubDhPdjFFTWZFUEF1S3RDTUlpZ0VQbmtJRmYyOVg5ZHk0T3RiUUZYRT0ifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

CMSCMS

Fewer than one-third of Accountable Care Organizations qualified for bonuses from Medicare in 2015.

And just 31 percent of ACOs generated savings of $466 million, according to a CMS announcement released Thursday.

CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program,” Clif Gaus, CEO of the National Association of ACOs, said in a response (.pdf) to the findings.

The savings were accumulated from 392 Medicare Shared Savings Program participants and 12 Pioneer ACO participants, according to CMS. Total savings grew 13 percent from 2014, when ACOs recognized $411 million in total savings.

The National Association of ACOS “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs,” Clif Gaus told FierceHealthcare via email, adding, “the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment.”

Hospitals more likely to admit children with private insurance

http://www.fiercehealthcare.com/payer/hospitals-more-likely-to-admit-children-private-insurance?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTXpNd1lqZGlNR0U1WkRJeCIsInQiOiJLOWhzWGhXZ2FrUHdBMEg5d1VNTnppNTR6TEh5XC9tQjI1bDgxcVlUUWNcL1wvSWt0SkRUck9vYm90K1VuSlZJUGFpQ3RubDhPdjFFTWZFUEF1S3RDTUlpZ0VQbmtJRmYyOVg5ZHk0T3RiUUZYRT0ifQ%3D%3D

Medicaid on paper and a stethoscope Medicaid on paper and a stethoscope

New research shows hospitals are more likely to admit children with private insurance over those with publicly funded plans, particularly during times when there are limited inpatient beds, an indication that reimbursement rates play a role in how hospitals manage pediatric patients in the emergency room.

Researchers from the National Bureau of Economic Research studied billing patterns for children in New Jersey that visited an emergency room between 2006 and 2012. The economists found that children with Medicaid or Children’s Health Insurance Program that presented to the ER with flu symptoms were 10 percent less likely to be hospitalized than those with private plans, according to the Washington Post.  During peak flu season, when there was a shortage of inpatient beds, children between 2 and 10 years old on Medicaid and CHIP were 20 percent less likely to be admitted.

Calif. hospital to pay 3 former employees $1.7M in harassment suit

http://www.beckershospitalreview.com/legal-regulatory-issues/calif-hospital-to-pay-3-former-employees-1-7m-in-harassment-suit.html

Community Hospital of Long Beach (Calif.) and the former manager of the hospital’s psychiatric unit have been ordered to pay $1.7 million to three ex-employees who alleged they were subjected to sexual harassment and discrimination, according to the Long Beach Patch.

The plaintiffs accused Keith Kohl, RN, who directed the hospital’s psychiatric unit and was employed by Memorial Psychiatric Health Services, of discrimination. The female plaintiffs alleged Mr. Kohl flaunted his homosexuality, creating a hostile work environment. They further alleged he gave preferential treatment to gay males.

In their suit, the plaintiffs argued their employment with the hospital was wrongfully terminated, while the hospital claimed they had been fired for putting a patient in restraints without a physician’s orders and lying during an investigation into the incident.

After nearly three hours of deliberation, the jury issued a verdict in favor of the plaintiffs, finding evidence of sexual harassment, discrimination, failure to prevent harassment and discrimination, wrongful termination, defamation and negligent supervision.

Wall Street Journal combs through nonprofit hospitals’ board-business ties: 6 things to know

http://www.beckershospitalreview.com/finance/wall-street-journal-combs-through-nonprofit-hospitals-board-business-ties-6-things-to-know.html

As some of the largest nonprofits in the U.S., hospitals face a major challenge — their board members or executives often have direct ties to organizations with which the hospital does business, The Wall Street Journal reports.

Here are six things to know about nonprofit hospitals and their business associations, according toWSJ.

The Life-Changing Magic of Choosing the Right Hospital

There’s an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospitals.

A great deal of the decrease in deaths from heart attacks over the past two decades can be attributed to specific medical technologies like stents and drugs that break open arterial blood clots. But a study by health economists at Harvard, M.I.T., Columbia and the University of Chicago showed that heart attack survival gains from patients selecting better hospitals were significant, about half as large as those from breakthrough technologies.

That’s a big improvement for nothing more than driving a bit farther to a higher-quality hospital.