Federal court judge dismisses hospital observation care suit

A federal court judge this week dismissed a lawsuit seeking to eliminate observation status in hospitals or at least require hospitals to inform patients when they are in observation so they can challenge Medicare coverage decisions.

The lawsuit, brought by 14 Medicare beneficiaries in Conneticut, argued that hospital stays for observation should count toward the three-day requirement to receive coverage or follow-up nursing home care, Kaiser Health News reports. The seniors argued that although there is little difference in care given to patients in observation status and those admitted as inpatients, they incurred thousands of dollars in nursing home bills, according to the article.

Only patients admitted to a hospital for three consecutive days are eligible for coverage or follow-up nursing home care, according to Medicare rues.

"We are very disappointed with the court's decision," Alice Bers, an attorney at the nonprofit Center for Medicare Advocacy, which represented the seniors told Kaiser Health News.

"The decision removes much of the responsibility for observation status from the Secretary of Health and Human Services and places it on hospitals and doctors, even though the Secretary is in charge of making sure that hospitals meet their Medicare obligations," she said.

But this won't likely end debate over the three-day rule.  

Last week an editorial published in the Journal of American Medical Association argued in favor of eliminating the Medicare requirement that patients spend three nights in a hospital to qualify for nursing home coverage. Lewis Lipsitz, M.D., of Hebrew SeniorLife, an affiliate of Harvard Medical School and the largest provider of elder care in the Boston area, said doing away with the rule would reduce costs and patient risk.

And earlier this month, Don Berwick, M.D., former administrator for the Centers for Medicare & Medicaid services, also called for the elimination of the rule, telling the Boston Globe that because of the rule, "[t]he patient ends up holding the bag, and that's not fair or appropriate." A commission appointed by Congress to analyze long-term healthcare solutions recently made the same recommendation.

To learn more:
- read the article

Related Articles:
Geriatrician: Eliminate Medicare's 3-night rule
Berwick: get rid of Medicare 3-day rule
Commission fails to reach consensus on long-term care
Observation stays exceed CMS guidelines
Medicare patients sue HHS over outpatient status

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