PLATTSBURGH — CVPH Medical Center has expanded its short-stay unit to help meet new requirements mandated by changes in federal and state policies.
The Centers for Medicare and Medicaid Services has changed the way it defines inpatient services, meaning that patients admitted to the hospital for observation may not be considered inpatients for insurance purposes.
“Medicare now defines a hospital stay spanning two midnights as being an inpatient admission,” said Debra Good, director of Case Management for CVPH.
Inpatient status had traditionally been determined by the severity of illness and the intensity of services, but the new guidelines require an inpatient-admission order and a written certification from the doctor stating that hospital care is required for more than two midnights, Good explained.
That determination will have a direct impact on a patient’s billing and may mean some resources covered by inpatient care are not covered as an outpatient.
“New York state has passed a new law that requires hospital patients who are placed into observation services be notified that the patient is not admitted to the hospital as an inpatient,” Good noted.
Patients can work with CVPH case managers to help identify what kind of impact their status will have on the cost of medications, co-payments and deductibles.
Although the new regulations impact Medicare patients, decisions made by the Centers for Medicare and Medicaid Services tend to drive everything that happens in health-care coverage, Good explained.
People can take a more proactive stance in their own health-care coverage by contacting their insurance providers to determine their coverage for inpatient and outpatient services, she suggested.
CVPH opened its short-stay unit in January 2011 with nine beds dedicated to mostly cardiology patients who needed further observation following their procedures.
“With this increased demand from the feds (to determine whether patients were being admitted as inpatients or for observation), we determined that we needed a unit for our observation patients,” said Joyce Favreau, director of the short-stay unit.
The unit now has 11 active beds, and the hospital has recently completed construction on space for five additional beds. Efforts are now underway to recruit staff to open the additional space soon, Favreau noted.
Although the criteria for determining patient status are complicated, the short-stay observation process has been very beneficial in providing patients with the care they need.
“We have a great staff that takes its job seriously,” Favreau said of the unit’s nurses and other staff members. “Our patients have consistently spoken highly of the staff.”
The Centers for Medicare and Medicaid Services defines observation as a set of services furnished to a patient while a decision is being made regarding the further treatment, including inpatient admission or discharge.
Observation allows the physician time to make a decision in moving the patient to the most appropriate treatment setting.
The new requirement also means that Medicare does not allow an observation stay to count toward the three-day hospital inpatient-stay requirement for payment for skilled care in a nursing home, a rule that may prevent some seniors from accessing a benefit for rehabilitation.
CVPH provides patients with information on the Medicare requirements for observation stays and also requires patients to acknowledge that they have received notification on outpatient observation services.