Experts: CMS observation notice needs work

regulatory

Two months before the Centers for Medicare & Medicaid Services implements a new law requiring hospitals to tell Medicare patients their admission status, doctors and healthcare experts have raised concerns about the agency's draft notice, according to Kaiser Health News.

While the notice clarifies that observation care allows doctors to decide whether patients are sick enough for formal admission, it fails to note that the decision isn’t necessarily final, according to Jay Kaplan, M.D., president of the American College of Emergency Physicians. Rather, he told the publication, hospital leaders can override a doctor’s decision if they decide a patient is better-suited to observation care. Meanwhile, if Medicare auditors determine a patient was admitted, but should have been placed in observation, Medicare will not pay for the patient's care.

The American Hospital Association, meanwhile, says questions remain about implementation of the requirement. For example, while the law requires notice after 24 hours have elapsed and before 36 hours, numerous states already have laws on the books requiring notice, but with different details in many cases, the AHA noted in a January letter to CMS. 

Rep. Lloyd Doggett (D-Texas), who co-sponsored the bill, also said that the form does not require hospitals to outline the reason patients are placed in observation care rather than admitted as an inpatient. “I am concerned that the proposed notice fulfills neither the spirit nor the letter of the law,” Doggett told KHN.

Medicare will accept feedback on the draft notice through Friday.

- read the article
- see the letter (.pdf)
- here's the draft notice (.pdf) via KHN