The law, called the NOTICE Act, requires hospitals to notify patients hospitalized for more than 24 hours if they are on observation status. The law won’t go into effect until next August, which is great, because it could be better.
The way the law is written right now, it’s almost like asking a patient under anesthesia to sign a consent form. Within the first 24 hours of being admitted to the hospital for a medical event, many people—especially older people—aren’t able to focus on complicated issues of their status and its consequences.
Being on observation status has significant financial consequences. Observation status is considered outpatient service by Medicare. All care, supplies and procedures are covered under Part B, not Part A, and therefore are subject to Part B's higher deductible and co-pays. On top of that, most hospital pharmacies do not contract for Part D drug payments. Patients who have to take their normal medicines while under observation status will have to submit reimbursement requests to Medicare.
If a patient requires skilled nursing care after being discharged, Medicare will only pay for it following three days of inpatient hospitalization. Being on observation status—an outpatient—doesn't count toward the three-day requirement.
One Woman’s $3,900 Surprise
Jean Arnau, an 84-year-old who spent five days in the hospital with a fractured spine is a perfect example of how observation status poses consequences after discharge. She was in a hospital bed, wore a hospital gown and ID bracelet, ate hospital food and received regular nursing care.
When she was discharged and needed to transfer to a skilled nursing facility for rehabilitation, her family learned that she had never been formally admitted as an inpatient to the hospital at all. Instead, she'd been classified as an outpatient under observation and the nursing facility would charge almost $4000.
What To Do Until There’s a Real Fix
It’s great that the NOTICE Act requires patients receive “accurate, real-time information with respect to their classification, the services and benefits available to them, and the respective cost-sharing requirements they are subject to." It’s just that doing it within 24 hours of admission is too often not fair.
Talk to your clients, and their loved ones, before the need arises. The Center for Medicare Advocacy has put together a thorough packet explaining what your clients can do to protect themselves.
You can help by discussing these things with them:
• Urge them to ask about their status each day they are in the hospital. It can change from day to day.
• Tell them to ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
• Tell them to ask their primary care physician to state whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
• If they need rehab or other continuing care but learn that Medicare won't cover a a skilled nursing facility, tell them to ask their doctor if they qualify for similar care at home through Medicare's home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
• After the fact, let them know they can appeal a Medicare decision of non-coverage. All the avenues for appeal are spelled out in the Center for Medicare Advocacy’s packet.
Preparing loved-ones before they are hospitalized isn't a fix to law, but it will empower future patients with a plan and knowledge of their rights. After having these conversations, patients will be more enabled to fight for their rights while Washington hopefully gets around to making much needed improvements to the law.
Phillip Lanier
Health Policy Intern
Health & Disability Advocates
Halloween Marks a Scary Time for Health Care in Illinois
If things don’t change soon, health care could be in for major setbacks in Illinois. The State budget battle is approaching its fifth month and counting. So far, Medicaid payments continue per court order, but other services are beginning to run out of money:
- State payments to 911 call centers throughout the Illinois have been suspended, putting emergency services in jeopardy.
- Illinois has stopped paying medical and dental claims for 150,000 state employees. The long-term cost of delayed care for a group of this size could be far greater than the cost of paying for care and preventative care today.
- The state’s Psychiatric Leadership Capacity Grant, which was $27 million in the State’s FY2015 budget, is no longer being funded, affecting most of the 140 community health centers in Illinois and thousands of people who rely on them for psychiatric care.
It’s Not Too Late to Raise Your Voice!
Contact your State legislators to let them know how concerned you are about the future of health care in Illinois. Tell them that Illinois seniors and children are especially vulnerable. We can’t let cuts affect them.Many program cuts will result in greater costs to the State in the not-so-long run. For example:
- Home care services and home delivered meals to seniors citizens cost a fraction of the $75,000 annual cost of nursing home care. Cuts to these programs will mean more seniors ending up in nursing homes, paid for by Medicaid.
- Cut backs to after-school programs and Department of Children and Family Services support for older children will mean more kids and young adults intersecting with the justice system. Even short-term incarceration can pay for a full year of after-school activities for a child.
- Cut backs to mental health services will only cause an increase in city and country jail populations where the State will not only have to provide mental health services, but food, clothing and shelter.
Phillip Lanier
Health Policy Intern
Health & Disability Advocates
Chicago needs a plan to sign up its uninsured; here's what to do
Health care coverage has an impact on the economic well-being of lower- and moderate-income people; therefore enrolling the uninsured should be considered a key economic strategy for Chicago and all of Illinois. Unfortunately, this isn't the case.
Sixty-three percent of Illinois' working population eligible for a private path to health coverage under the Affordable Care Act is still uninsured, with large swaths residing in Chicago (see a breakdown of the numbers across Illinois here).
Given those statistics, Mayor Rahm Emanuel needs all hands on deck—from business leaders to health insurance brokers, from community institutions like public libraries to religious leaders—to encourage people to sign up.
Open enrollment for 2016 health insurance coverage starts Nov. 1, so the city is in serious need of a plan. We propose a Commission for Healthy Chicago, similar to the mayor's effort on violence prevention, comprising city staff and community, business, faith and health care leaders to build a cross-sector strategy for outreach and enrollment. Emanuel can improve the economic security of working-poor Chicagoans simply by putting the clout of his office behind such a strategy.
Chicago shouldn't expect the state to lead. In the midst of the state's fiscal disarray, Get Covered Illinois has lost most of its staff and has stated it will rely more heavily on “partners” such as providers, brokers and nonprofits for enrollment support. GCI's limited capacity can't get the job done; nor should the city and state expect nonprofits and health care providers to fill the gap in funding or leadership.
The Task Ahead
With only 37 percent of the estimated 942,000 marketplace-eligible residents having enrolled, Illinois ranks 20th out of the 37 states that operate their marketplaces using the federal HealthCare.gov website.
Here's another way to look at it: Two years into ACA's health insurance efforts, almost two-thirds of Illinois' marketplace population—the lower- to moderate-income people for whom the ACA was created—remain uninsured. Almost half of them are eligible for a tax credit or subsidy to make their plan more affordable.
Overall, about 73 percent of the nearly 600,000 people who are eligible but still uninsured live and work in the Chicago metro area. Within these areas there are significant proportions of the population who do not speak English as their primary language. In nearly half the metro area, at least one-third of the population speaks Spanish or another non-English language. In several of these areas, primarily in Chicago and suburban Cook County, more than 50 percent do not speak English as their first language. Notably, the areas with the highest proportion of non-English speakers are the same areas with the lowest share of eligible population enrolled.
Other states have successfully enrolled low- to moderate-income people in the ACA health insurance marketplace. They have done this through:
• Use of data to target communities with large, underserved marketplace-eligible populations.
• Exploiting numerous local avenues to provide extensive education and outreach, including through events and local media, to directly connect the uninsured with help to enroll in coverage.
• Meaningful collaboration with brokers and the small-business community.
A healthy Chicago economy goes hand in hand with a healthy population that is ready to learn, work and is not burdened by health care costs. Let's not let Chicago and Illinois fall behind when it comes to covering working families.
This article originally appeared in Crain's Chicago Business.
Barbara Otto
CEO
Health & Disability Advocates
Whose Stethoscope is it? The View's Joy Behar Algorithm
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Memes Responding to The View's Joy Behar Nurse-Doctor Stethoscope Comment.
Nurses swarmed Facebook and Twitter during their rare combined bathroom/lunch break to support the Miss America contestant and to defend their profession against the incredible remarks.
What better way to support nurses in their rage than to honor their duty to service with a handful of memes. Please enjoy this original collection of The View Joy Behar Nurse Memes, courtesy of The Happy Hospitalist.
"So you insulted 3 million nurses and still have a job?"
"Prepare yourself. Nurses are attacking!"
"What do you mean doctor's stethoscope!"
"One does not simply insult a nurse and get away with it!"
"What if I told you angry nurses are never a Joy to Behar!"
"If you could stop calling it a doctor's stethoscope, that would be great!"
"America is a land of opportunity. All you have to do is not say "doctor's stethoscope!"
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Stay the Course with SHIP
State budget cuts are not the only threat to seniors and people with disabilities. Federal reductions may be coming as well.The US Senate is considering a 42% reduction in funding to the State Health Insurance Assistance Program, which counsels seniors and people with disabilities on their Medicare health plan options. SHIP funding would drop to a mere $20 million, diminishing the numbers and quality of the SHIP workforce.
SHIP is Necessary Now More than Ever
Every day, 10,000 Americans become eligible for a Medicare system that is increasingly more complex. Medicare beneficiaries pay the price for the confusion:
- 700,000 Medicare are paying the Part B Late Enrollment Penalty because they missed the deadline to sign up,
- Medicare Part D beneficiaries in Low-Income Subsidy are often unaware of lower priced options,
Poorer Trained, Less Helpful
The federal cuts would compromise SHIP's ability to adequately serve everyone who needs help. One and a half million fewer people would receive assistance. Moreover, most of the SHIP counselors are volunteers who donate almost two million hours of help. Cuts could also result in reduced or compromised volunteer training, which increases the risk of erroneous advice and reduces the quality of services beneficiaries receive.
No Substitute
Those in favor of the cuts claim there are less costly alternatives to SHIP. This is untrue. The materials suggested as substitutes, 1-800 Medicare, Medicare.gov and the Medicare Enrollment Handbook, all list SHIP as a resource for people to use with additional questions. A brochure is no substitute for one-on-one, expert advice.
What You Can Do
Tell your Senator to fight cuts to the SHIP program, that your family, friends, even you personally, benefit from the free services that SHIP counselors provide. It's easy:
- Send our Senators this model letter drafted by the National Council on Aging. Just copy and paste the text into their contact forms: Sen. Kirk's form Sen. Durbin's form (remember to sign your name!)
- Tweet your advocacy with this graphic we created – and tag @SenatorKirk @SenatorDurbin
- Feel free to personalize with your story, or the story of loved ones. Personal stories make a difference!
Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates
Patchwork of Short-Sighted Solutions Leave the State's Most Vulnerable at Risk
The following letter to the editor originally appeared in the Chicago Tribune.
The expectation that Medicaid-funded long-term care providers will continue to provide care to low-income and vulnerable citizens without payment for those services is short-sighted and doesn’t fully consider the strains that it places on them - and the direct care staff who provide the hands-on care to elders and people with disabilities.
For providers that can keep their doors open without Medicaid funding, it may mean cutting costs by laying-off staff, leaving the remaining nursing assistants to work longer shifts at the nursing home. Or, it may result in a consumer getting care from a new home care aide when her regular aide – who knew her schedule and needs – had to quit after losing her day care subsidy – another casualty of Gov. Rauner’s and the legislature’s inability to act and pass a budget.
For those providers that cannot keep their doors open without Medicaid payment, where are the people who relied on them for housing, for a meal, for a bath, or transportation to a medical appointment supposed to turn for care? In many instances the home care aide is the professional who checks in to make sure that her client is well, taking her medication, and isn’t at risk for injury. And for those receiving care in a nursing home, there is often not another option for them to receive 24-hour care.
These are realities that lawmakers are not taking into consideration as the budget impasse lingers on without a solution in sight. While ensuring that Medicaid providers in Cook County who serve children continue getting paid was a great solution, none seems to be in sight for the thousands statewide who rely on Medicaid services for care in nursing homes or to live safely and with dignity in their communities.
A patchwork of short-sighted solutions will only leave the state’s most vulnerable at risk. It is time to pass a budget with sufficient revenue to fund the services that seniors and people with disabilities rely on and to stabilize the long-term care employers and workers who provide the services.
Tameshia Bridges Mansfield
Midwest Director
Paraprofessional Healthcare Institute