Berwick: Get rid of Medicare 3-day rule

The simmering controversy over observation care might reach a boiling point now that Don Berwick, M.D., former administrator for the Centers for Medicare & Medicaid Services, has jumped into the fray.

When Berwick, who is now an official candidate for Massachusetts governor, led Medicare from July 2010 to December 2011, he considered eliminating Medicare's three-day payment rule for hospitals, a position he reinforced during a recent interview with The Boston Globe.

"The patient ends up holding the bag, and that's not fair or appropriate," he told the newspaper, adding that "Medicare should get rid of that rule."

With the three-day payment rule, Medicare intended to give doctors 24 hours to 48 hours to assess whether a patient should be admitted to the hospital or go home. However, observation stays at hospitals often exceed CMS guidelines, with 8 percent of Medicare patients having observation stays lasting longer than 48 hours in 2011, up from 3 percent in 2006, according to the article.

Heeding calls to end the three-day rule, U.S. Representative Joe Courtney, (D-Conn.) filed legislation three years ago that would get rid of the distinction between inpatient and observation status, allowing patients who spend at least three days in a hospital--no matter the classification--to qualify for coverage if doctors deem rehabilitation care necessary, the Globe noted.

To help end the controversy surrounding observation status, last month CMS finalized the Hospital Inpatient Prospective Payment System (IPPS) rule to clarify when a patient should be admitted to the hospital, determining observation care should not exceed "two midnights."

Courtney told the Globe the new IPPS rule could help but is no solution. That rule also got flak from teaching hospitals for unintentionally banning residents from admitting patients.

Akin to Courtney's plan, some patients want the observation care label removed entirely, and they're going to legal lengths to make it happen. A group of Medicare patients filed a lawsuit against U.S. Department of Health & Human Services Secretary Kathleen Sebelius to eliminate the term, FierceHealthFinance previously reported.

For more:
- read the Globe article