Short Takes On News & Events

Rep. Courtney Pushes Bill To Expand Medicare Coverage Of Nursing Home Stays

By Susan Jaffe

August 9th, 2012, 6:00 AM

Congress may be in recess, but Rep. Joe Courtney (D-Conn.) isn’t taking a vacation just yet.  He went to a New London nursing home Wednesday to drum up support for legislation that would help residents such as a 98-year-old woman whose life savings were wiped out by nursing home bills Medicare wouldn’t pay.

Rep. Courtney

That woman’s niece, Candice Antrop, said her aunt went to the Beechwood Rehabilitation and Nursing Center several times for rehab after being discharged from the hospital. But even though the hospital and doctors recommended the rehab, Medicare did not pay for it. That’s because Medicare will cover such nursing home stays only if the patient had been admitted as an inpatient to the hospital for at least three days. Her aunt’s hospitalizations did not qualify because she was under observation care instead of inpatient care. The nursing home cost her aunt tens of thousands of dollars over several years.

“She couldn’t go home,” said Antrop.  “She couldn’t walk.”

Her aunt, who didn’t want her name used, is now a full-time resident at Beechwood, and the facility’s director said that Medicaid, the government health program for low-income people, is paying the current bill.

Medicare beneficiaries across the country have often been surprised by the observation exemption, since hospitals are not required to inform patients that they are receiving observation care.  Researchers at Brown University found that the number of Medicare patients who enter the hospital for observation is rising dramatically — up 25 percent from 2007 to 2009 — even though Medicare enrollment and hospital admissions have declined slightly.  They also found that observation patients are staying in the hospital for extended periods of time, with 45,000 in 2009 staying 72 hours or longer — nearly double the number the number in 2007, and well past Medicare’s recommended 24 to 48 hours.

Courtney’s legislation, co-sponsored by Rep. Tom Latham (R-Iowa),  would change Medicare rules to allow the days in observation to count toward the required three-day hospital stay. It has bipartisan support, as does as a similar bill introduced by Sens. John Kerry (D-Mass.) and Olympia Snowe (R-Maine).  It has also been endorsed by AARP, the American Medical Association, and the American Health Care Association, a nursing home industry trade group, among others.

“The trend of hospitals coding patients as observation is accelerating with every passing year, and the impact on families is financially catastrophic,” said Courtney.

But according to the initial feedback he’s received from Medicare officials, Courtney said the legislation’s impact on Medicare spending “would have a miniscule additional cost, because you’re not creating a new benefit.”

“This isn’t a clinical issue or a care issue,” said Kathy Pajor, Beechwood’s president and executive director. “It’s all about coding and paying the bill. It’s a technical issue that can easily be adjusted by the flip of a code.”

Observation status also affects Medicare patients while in the hospital, because Medicare won’t pay for their routine daily medications for conditions that may be unrelated to the problem that brought them to the hospital.  Because there are no limits on what hospitals can charge for these drugs, some observation patients have been billed  $18 for one baby aspirin and $71 for one blood pressure pill that costs 16 cents at a local pharmacy.

A Medicare spokesman said officials could not comment, because the issue is under litigation. The Center for Medicare Advocacy, based in Connecticut, has filed a class-action lawsuit against the federal government on behalf of Medicare patients seeking to eliminate the observation designation.

Contact Susan Jaffe at Jaffe.KHN@gmail.com

8 Responses to “Rep. Courtney Pushes Bill To Expand Medicare Coverage Of Nursing Home Stays”

  1. lucky7 says:

    Anyone with experience in the private nursing home industry will probably agree that these institutions are in business to maximize profits. That is their top priority. For nursing home operators, offering better care or legislating longer stays will most likely have an adverse effect on their bottom line. More evidence that free market capitalism never works when it comes to designing and implementing social programs. Every other industrialized nation in the world has come to realized this truth long ago and they have migrated to single-payer government control. Free enterprise does not work in nursing homes or anywhere else where health care is delivered. The profit motive will always be the top priority and providers will always cut corners and skimp on the delivery of goods and services just to meet their quarterly objectives. It takes government to legislate kindness and compassion. Capitalism will never be kind and compassionate. Never!

  2. elder advocate says:

    Obviously Lucky 7 doesn’t know a thing about nursing homes. First they are NOT INSTITUTIONS. They are HOMES for people who cannot take care of themselves any longer. Second, it is again obvious that Lucky 7 was never a care giver who had to pay for the care when his/her loved one was in a hospital and didn’t have a three day stay.
    Medicare won’t pay. In the article Candace stated her aunt was depleted of all her money because the observation days in the hospital did not count for the three days.
    AND, paying privately costs more than what Medicare would have paid.
    My father did not have a three day stay and I had to pay privately. Medicare would have reimbursed the nursing home at a lower rate than I was paying. There is nothing in the aricle that someone would get better care if Medicare paid.
    Finally, Lucky 7 if you don’t like capitalism go live in another country. You have freedom of choice.

  3. lucky7 says:

    A very smart person once told me, always avoid any dialog with a moron. Freedom of choice? Yeah! I choose single-payer health care for all. After Obamacare gets repealed, it’s the only option left on the table if we want to control costs. I was hoping Republicans would be stupid enough to repeal their very own idea (Heritage Foundation, Romneycare, etc.) and, just as I thought, they took the bait!

  4. Kate says:

    Lucky7, why is it that liberals often resort to name calling when talking about important policies?

  5. Rich says:

    Lucky and author of article are fools. Medicaid pays for 80 % of nursing home expense. People hide assets and let taxpayers pay for their stay so that they can give children/family asset base. American taxpayers pay from womb to tomb now. We pay for everything but burial expense and SS pays $250 for that.

    Lucky, just who do you think will continue to work when everyone get free lunch and money back?
    Try to think beyond your nose- You are major problem our country has. If you hve any doubt, please read a newspaper about Europe’s problems. How do you think they got is such a mess?

  6. Marie says:

    The system most certainly is broken, but I don’t think any of you understand how this really works. When you have an elderly family member that cannot get the care they need becuase the hospital “determined” they should be kept under “observation” instead of actually “admitted as an inpatient”, Medicare will not pay for care after they are discharged. No matter their financial situation. So if you have a person that has no way of taking care of their illness or injury, it is not Medicares problem, it becomes an issue for the family to deal with whether they have the means or not. It is pretty amazing that we all pay taxes to provide this “safety net”, yet if someone actually needs to use it, they’ll find out that the net is not there for them. In fact I’m not sure that hospitals even classify people as “inpatient” any longer, becuase medicare will audit them and find that the patient should have been under “observation” rather than admitted as inpatient, so the hospital does not get paid one cent. They error on the side of cuation and elect to keep 90% of patients under observation, so they at least get paid for a portion of services provided. This is not about liberals or conservatives, its about people receiveing the care they need, the care their taxes were supposed to pay for!!

  7. Tommy gun says:

    Medicare is at fault here. The 3 day hospital requirement has always been there. However, someone at Medicare got the brilliant idea to think that an observation day in a hospital is like not really being in a hospital. The first time I saw this, many years ago, I was shocked. Medicare beneficiaries now had hospitals controlling their benefits after they left the hospital by how they coded their stay. If you were in the hospital for three days but the first day was coded as observation, then you didn’t meet the three day stay requirement, even though you had been in the hospital three days. I don’t even think a new law is needed, but rather Medicare needs to be told by Congress to not change the law by their own interpretations. They are not elected to do that. They are to administer the benefits as described by law.

  8. Carol Eblen says:

    It was the Advantage Companies who lobbied Medicare (the junior partner, to impose the three day hospital rule many years ago in order to protect their profits on the sale of the Advantage policies.

    Under the law, The Avantage Medical Insurance policies must provide AT LEAST as MUCH and never LESS than original Medicare.

    FOLLOW THE MONEY!!! In 2009, Anne Zieger of Fierce Healthcare reported ” The idea behind Medicare Advantage plans —in which the government pays private healthcare organizations a fee to manage care for Mediccare beneficiaries —-was that managed care groups might be able to care for beneficiaries more cheaply and effectively than traditional fee-for-service Medicare.

    She goes on to say …………….But that doesn’t seem to be happening ………The report concludes that Medicare Advantage plans, which will be paid $11 billion this year, are getting $1,140 more per enrollee than it would cost to care for the same number of patients under FFS Medicare.”

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