Bill to Clarify Three-Midnight Rule for Medicare Patients Gains Support from Congress, Hospitalists

The Hospitalist. 2014 May;2014(05):

May 1, 2014 | The Hospitalist

U.S. Representative Joe Courtney (D-Conn.)

Ann Sheehy, MD, MS, FHM, a hospitalist speaking on behalf of the Society of Hospital Medicine on a recent conference call I hosted, detailed the scenes she sees every day with her own patients. She described how doctors, knowing that a patient lacks the means to pay for rehabilitative care out of pocket and the support system to recover safely at home, sometimes keep the patient in the hospital longer, at a higher cost to Medicare. In other cases, Dr. Sheehy noted that patients end up back in the hospital soon after being discharged, having foregone expensive SNF care and subsequently suffered preventable injuries and illnesses. Both of these outcomes are bad for patients—and bad for Medicare expenditures.

Three-Day Fix

While the problem of observation status treatment is complex, the solution is simple.

As observation status becomes more ingrained in the healthcare lexicon, a legislative fix to restore the three-day hospital stay standard is needed now more than ever. Three days in the hospital—whether as an inpatient or under outpatient observation—should count for three days in the hospital when Medicare determines eligibility for SNF coverage.

My bill, H.R. 1179, is the most direct solution to rectify the flaw that leaves hundreds of thousands of beneficiaries wondering how their stay in the hospital does not “count” and scrambling to figure out how to pay for care—or foregoing it entirely. The strong support in the advocacy community for this legislation—especially from SHM—and the sway of outside groups cannot be overstated. In Washington’s current climate, the only thing that moves bipartisan issues forward is outside pressure.

Together, I hope hospitalists and members of Congress will reach the critical mass needed to pass this legislation and ensure that Medicare beneficiaries are covered for medically necessary care.

Joseph “Joe” Courtney is the U.S. Representative for Connecticut’s second congressional district, serving since 2007. The district includes most of the eastern third of the state, including Norwich and New London.

How to Get Involved

SHM has prioritized Rep. Courtney’s legislation addressing observation status and SNF care. Join the effort to pass this legislation by:

Telling your members of Congress to support H.R. 1179 through SHM’s Legislative Action Center at www.hospitalmedicine.org/advocacy. It is quick, easy, and effective.
Sharing your perspectives on and experiences with observation status with the SHM Government Relations team at advocacy@hospitalmedicine.org.
Learning from other hospitalists about how they handle status determinations, SNF coverage, and other observation care issues on HMX at connect.hospitalmedicine.org.