Government Controlled Medicine
Friends and Family:
This happened to a retired physician friend of mine. Ironically, he and I are both physicians and had no idea this rule existed. Be aware if you find yourself in an ER or have loved ones who may at some point. Another perfect example how government bureaucrats are making clinical decisions as to what is reimbursable while your physician is being bypassed in the entire process. This will get worse as "non-physicians" and the hospital cartels undermine your doctor's authority through employment and monitoring of physician compliance with the convoluted, immoral rules and regulations of Obamacare. His words below:
Medicare Patients: Beware Hospital "Observation" Status
Medicare patients need to be aware of a several year old 'rule' involving payment for hospitalization.
Patients staying in a hospital under "observation" status (in lieu of a formal admission) might be surprised to learn
that Medicare will not pay the patient for costs incurred during that time. Those patients will be directly responsible for
all hospital charges levied during that observation period.
This week, my doctor discovered that my pacemaker battery was just about at the end of its useful life. The very next day (a Saturday afternoon), while waiting for a call to schedule a replacement, I suddenly noted a 'thump' in my chest, realized I had a slow heartbeat, and almost fainted when I stood up from a seated position. I was also a little clammy at that moment. Aware that I was in heart block, but unsure about what to do, I telephoned the on-call physician, who urged me to be seen in an ER. My wife drove me to the hospital where my electrophysiologist planned to insert a new pacemaker in the near future.
After 6 hours I was told that the hospital felt I should stay overnight for monitoring. Aware of Medicare's payment policy regarding "observation," and not being informed of my 'admission' status by the doctor who had seen me, I asked if I were being admitted, or simply going to be "observed." I was told the latter, since I "didn't meet criteria" for admission. What I learned was that a nurse (who had not seen me) was the one who made the decision about these "criteria" - not the doctor.
This is an interesting payment scheme devised by the government. It saves money for Medicare (which is going bankrupt) and provides extra income to the hospital while screwing the patient. As well, by separating the role of the decision-maker (nurse) from the treating party (doctor), that nurse is not compelled to act as the patient's advocate. Rather, she is the hospital's financial ally. The doctor - your traditional advocate - has no say in this decision. (Of note, when I was asked to sign various consent forms (including agreement to pay for services rendered) upon admission to the ER, the small electronic device I signed did not include any verbiage concerning my 'agreement' with the hospital. That information was confined to the tech's computer screen, and not readable by yours truly.)
Not knowing how many days it would be before my doctor would schedule me for a pacemaker replacement (and wondering how many thousands of dollars of costs I might rack up while waiting), feeling pretty secure in the fact that I would not be endangering myself, I walked out.
What was most interesting during this learning experience was that neither the doctor who treated me, nor the hospital administrator who came to my bedside at my insistence, knew about this payment policy of Medicare. They learned while waking up someone from the billing department at 2 AM who confirmed what I had told them.
If nothing else, we need to insist that EVERY American of Medicare age participate in Medicare equally - Congress, as well as all those in theSupreme Court. We must demand that Everyone responsible for saddling us with Obamacare live by its rules. That is the only way we can hope to return common sense and common decency to medical care - and payment thereof.
This happened to a retired physician friend of mine. Ironically, he and I are both physicians and had no idea this rule existed. Be aware if you find yourself in an ER or have loved ones who may at some point. Another perfect example how government bureaucrats are making clinical decisions as to what is reimbursable while your physician is being bypassed in the entire process. This will get worse as "non-physicians" and the hospital cartels undermine your doctor's authority through employment and monitoring of physician compliance with the convoluted, immoral rules and regulations of Obamacare. His words below:
Medicare Patients: Beware Hospital "Observation" Status
Medicare patients need to be aware of a several year old 'rule' involving payment for hospitalization.
Patients staying in a hospital under "observation" status (in lieu of a formal admission) might be surprised to learn
that Medicare will not pay the patient for costs incurred during that time. Those patients will be directly responsible for
all hospital charges levied during that observation period.
This week, my doctor discovered that my pacemaker battery was just about at the end of its useful life. The very next day (a Saturday afternoon), while waiting for a call to schedule a replacement, I suddenly noted a 'thump' in my chest, realized I had a slow heartbeat, and almost fainted when I stood up from a seated position. I was also a little clammy at that moment. Aware that I was in heart block, but unsure about what to do, I telephoned the on-call physician, who urged me to be seen in an ER. My wife drove me to the hospital where my electrophysiologist planned to insert a new pacemaker in the near future.
After 6 hours I was told that the hospital felt I should stay overnight for monitoring. Aware of Medicare's payment policy regarding "observation," and not being informed of my 'admission' status by the doctor who had seen me, I asked if I were being admitted, or simply going to be "observed." I was told the latter, since I "didn't meet criteria" for admission. What I learned was that a nurse (who had not seen me) was the one who made the decision about these "criteria" - not the doctor.
This is an interesting payment scheme devised by the government. It saves money for Medicare (which is going bankrupt) and provides extra income to the hospital while screwing the patient. As well, by separating the role of the decision-maker (nurse) from the treating party (doctor), that nurse is not compelled to act as the patient's advocate. Rather, she is the hospital's financial ally. The doctor - your traditional advocate - has no say in this decision. (Of note, when I was asked to sign various consent forms (including agreement to pay for services rendered) upon admission to the ER, the small electronic device I signed did not include any verbiage concerning my 'agreement' with the hospital. That information was confined to the tech's computer screen, and not readable by yours truly.)
Not knowing how many days it would be before my doctor would schedule me for a pacemaker replacement (and wondering how many thousands of dollars of costs I might rack up while waiting), feeling pretty secure in the fact that I would not be endangering myself, I walked out.
What was most interesting during this learning experience was that neither the doctor who treated me, nor the hospital administrator who came to my bedside at my insistence, knew about this payment policy of Medicare. They learned while waking up someone from the billing department at 2 AM who confirmed what I had told them.
If nothing else, we need to insist that EVERY American of Medicare age participate in Medicare equally - Congress, as well as all those in theSupreme Court. We must demand that Everyone responsible for saddling us with Obamacare live by its rules. That is the only way we can hope to return common sense and common decency to medical care - and payment thereof.