As the Covid-19 public health emergency ends, many older adults who need a post-hospital stay in a skilled nursing facility (SNF) will be in for an unpleasant surprise: Traditional Medicare may not pay. The change, one among dozens that affect older adults, restores rules from before the pandemic. But they are complicated and will shock many patients and their families, [...]
The coronavirus pandemic and the fast-moving federal response to it is upending long-standing rules and practices for caring for older adults. Some changes will be incredibly disruptive, while others may increase support for vulnerable seniors. Here are some of the ways they are affecting how we care for our parents. No more nursing home visits. Just a week ago, the [...]
No issue generates more anger and confusion among Medicare recipients than observation status—that hospital stay that really isn’t a hospital stay. Over the holidays, I got an earful from three people who had been treated at a hospital by hospital staff yet not admitted to the hospital. A typical case goes like this: A person comes to a hospital emergency [...]
Two of the greatest sources of frustration for Medicare recipients and their families are observation status and the government’s incredibly complex appeals process. On Monday, a federal judge in Hartford CT, certified a class action lawsuit aimed at addressing both. The judge’s eventual decision in the case (Alexander v. Price) could have far-reaching effects on both the burgeoning use of [...]
Imagine your mom has a stroke. Once she is stabilized, she is sent to a skilled nursing facility for rehab. Then she goes home and gets some home health care and additional physical therapy. Medicare may pay, but for how long? For many years, that was decided by the “improvement standard.” In other words, as long as this care helped [...]
One-third of nursing homes residents are admitted to the hospital at least once each year, and half of those admissions could be avoided. Preventing them could protect hundreds of thousands of older adults from potential harm and save Medicare billions of dollars. The problem is neither new nor surprising. But it is tough to fix. Last week, the federal Centers [...]
Of all the complex rules that plague fee-for-service Medicare, few are harder to understand and potentially more important for seniors than observation status. By now, many older adults have heard the phrase. But they are still not clear what it means. A new study by AARP sheds some light on the consequences for seniors of hospital observation stays. But they [...]
While many seniors and their families may not be aware of it, consumer groups, hospitals, and nursing homes are fighting a major battle with Medicare over how the federal program pays for patients who are cared for in a hospital, but not admitted to the hospital. Seniors caught in this regulatory purgatory may have to pay thousands of dollars for [...]
Instead of admitting patients, hospitals are increasingly keeping them under "observation status." This decision results in lower Medicare payments to the hospitals and more out-of- pocket costs for patients. But it also means that Medicare is no longer paying for some admissions to nursing homes, and is instead shifting those expenses to residents and their families. What's going on? It is complicated. But here is [...]