Caretaking 102 - The Aftermath

Is there a social worker at the hospital who might be able to help with this? I wonder if there is anyone there who could translate/facilitate. After all, the hospital has a vested interest in making sure its bills get paid.

mtierney said:

thanks for all suggestions-- gratefully received!

Another lesson on the new health care reality:

When a patient enters ER care , their status is "observation" or "obs". If the patient is "admitted" to a bed within the hospital, make sure to ask the status so you know it is changed to admitted. If that box still reads observation, Medicare will not pay for transfer to rehab!

I spoke with numerous hospital personnel over this ridiculous glitch and was  always told that health insurance coverage confusion is the issue.

We may find out that Medicare won't be picking up the costs for the many,many tests etc received while in the hospital "> 

Obama signs Medicare observation stays bill

By Virgil Dickson  | August 7, 2015
President Barack Obama has signed a bill that requires hospitals to notify Medicare patients when they are receiving observation care but have not been admitted.

The bill is meant to help address a recurring problem for beneficiaries who face sticker shock when they go to a skilled-nursing or rehab facility after leaving the hospital and find that Medicare won't cover the tab. That's because to qualify for skilled-nursing facility coverage, beneficiaries must first spend three consecutive midnights as an admitted patient in a hospital; observation days don't count. 

Another common issue is beneficiaries facing unexpected Medicare Part B copays for drugs received during hospital care, since they were never actually admitted into the hospital and the drugs therefore are not covered under Part A.

The Notice of Observation Treatment and Implication for Care Eligibility Act would require hospitals to notify beneficiaries receiving observation services for more than 24 hours of their status as an outpatient under observation. The written notification would have to explain that because the beneficiary is receiving outpatient rather than inpatient services, they will be subject to cost-sharing requirements that apply to outpatient services. The notice also must say that the beneficiary's outpatient stay will not count toward the three-day inpatient stay required for a beneficiary to be eligible for Medicare coverage of subsequent skilled-nursing facility services.

Legal experts remain incredulous the bill will actually help address these scenarios, as it gives beneficiaries no formal recourse to change their status once they find out they're at a hospital on an observational basis.

“The new law will not cure these problems, but will at least give patients a warning before they spend thousands of dollars on care that will not be covered by Medicare,” Jeff Marshall, an elder law attorney in Pennsylvania, said in an analysis. “Some beneficiaries will likely decide to receive a different set of medical services after being notified of their observation status.”

Still, advocates are pleased despite the bill lacking a formal recourse path. “Medicare beneficiaries need to know what their hospital admission status is and how it affects their out-of-pocket expenses,” said Andrew Scholnick, a senior legislative representative at AARP.

“While this does not address all the issues associated with observation care, such as counting time in observation toward the three-day rule for receiving skilled-nursing care, it helps educate consumers and protects individuals from surprise hospital bills,” Scholnick added.

Provider groups such as the American Hospital Association and the American Academy of Family Physicians have also expressed support for the law.

The next step is that the CMS must begin the rule-making cycle and release the rule for public comment. The agency has released no timeline for when this process will occur.

http://www.modernhealthcare.com/article/20150807/NEWS/150809895

This "observations vs. admission" thing is really a bit of a mess.  I feel for you.

I hope to goodness mtierney and her husband don't have a document in their pile that says they acknowledge receipt of this information.   not that it really helps even if they were NOT notified. Is there any recourse at all if someone doesn't get the memo?

PeggyC said:

I hope to goodness mtierney and her husband don't have a document in their pile that says they acknowledge receipt of this information.  "> not that it really helps even if they were NOT notified. Is there any recourse at all if someone doesn't get the memo?

Why would that make a difference?  There still is no recourse to notification of observation status.  In any case, mtierney acknowledges that her husband was in the hospital for fewer than three midnights so the legislation would have no impact on their situation.  

 You are right, it would make no real difference. But if it were me, it would make me feel worse to realize that I had known all along and had signed a document that I forgot about. But it could easily happen, the way things feel when you are checking a loved one into the hospital.

Agreed, which is why this needs to be communicated verbally during the admission process, whether it be a formal admission or an admission for observation.

joan_crystal said:

PeggyC said:

I hope to goodness mtierney and her husband don't have a document in their pile that says they acknowledge receipt of this information.  "> not that it really helps even if they were NOT notified. Is there any recourse at all if someone doesn't get the memo?

Why would that make a difference?  There still is no recourse to notification of observation status.  In any case, mtierney acknowledges that her husband was in the hospital for fewer than three midnights so the legislation would have no impact on their situation.  

I'm confused.  

I understand that as it relates to Medicare coverage for rehab, the observational vs. admission is irrelevant because it was less than 3 days stay.

However, observation vs. admission matters enormously in terms of who pays for the 2 days of observation in the ER. In this case, mtierny is going to be stuck paying a percentage of these costs o because it is classified as outpatient services and not fully covered by Medicare.

With regard to the ER expenses, whether or not the patient was notified of his status as "under observation" and what that meant in terms of Medicare coverage definitely matters.  

Agreed.  Observation vs admission does matter enormously in terms of the patient's responsibility to pay for some or all of the cost of treatment received.  Having or not having written notification of this policy probably won't matter much when it comes time to pay the bills.

wow..double wow!!

Never heard about that legislation

First time I was told he was an obs patient was when we were told he was being discharged! After he spent a harrowing day in the ER  and we were told he was being admitted to the 4th floor and we were introduced to the admitting physician we believed that constituted admission!

There was an impressive line up of blood work, ultra sound, electrocardiograph and ct tests ordered! Tests were still taking on the morning of his discharge day.

Well, that is maddening. It does seem ambiguous, although you would still come up short in the matter of hours/days. It can't hurt to ask, I think. The worst that can happen is they will say no. 

the future of modern hospitalization: place patient/guest (new euphemism in use) on the moving platform heading toward the parking lot. Once the problem is at home, with one caretaker, no equipment, the hospital is off the hook.

My calendar for May and June, with July heading in the same direction

More on the latest hospital merger and hospitals need to save Medicare $$$

By Susan K. Livio | NJ Advance Media for NJ.com 
Follow on Twitter 
on June 21, 2016 at 10:28 AM, updated June 21, 2016 at 5:21 PM

Hospitals also agreed to take sizable cuts in Medicare funding in order to fund the Affordable Care Act with the promise of treating more insured patients. But in order to make the finances work, large hospital systems have merged and most independent community hospitals have been snapped up by chains. 
"There has never been a more exciting time in health care. By harnessing the collective knowledge and resources of both Hackensack University Health Network and Meridian Health, we are creating a world class health network," said Robert C. Garrett, who is co-CEO of the new system with Meridian's CEO John Lloyd.
Hackensack Meridian Health is now the second largest hospital system in the state, behind the marriage of Barnabas Health and Robert Wood Johnson Health System in March. 
In January, Meridian Health acquired Raritan Bay Medical Center in Middlesex County, extending its footprint into Middlesex County for a combined market of 1.5 million people.

Meridian's properties also include Jersey Shore University Medical Center, Neptune; Ocean Medical Center, Brick; Riverview Medical Center, Red Bank; Southern Ocean Medical Center, Manahawkin; Bayshore Community Hospital in Holmdel.
Hackensack's properties include the flagship hospital; HackensackUMC Moutainside in Montclair; HackensackUMC at Pascack Valley in Westwood, and Palisades Medical Center in North Bergen.
Before the merger, Hackensack and Seton Hall University announced the launch of a medical school, with an inaugural class planned for the fall of 2018, Garrett said. 
Representatives from both hospitals' boards of trustees will continue to serve in those roles overseeing a joint board led by Hackensack's Joseph Simunovich and Meridian's Gordon N. Litwin.
The merger required the approval of the state Health Department and Attorney General's Office, and both signed off within the last two weeks, hospital officials said. A judge approved the merger Monday.
Health Commissioner Cathleen Bennett lauded the merger in a joint statement with the hospitals.
"Across the country, health care organizations are partnering to increase access to care, reduce costs and improve clinical outcomes," Bennett said. "We welcome the new Hackensack Meridian Health merger, which will help ensure that New Jersey hospitals and health systems remain ahead of the curve in comprehensive health care delivery." 

Even with all the knowledge of rules, no one should be forced to 'fight city hall' to get care that is reasonable and that a person can assume has been written into Medicare, and secondaries. And what happens to someone with no spouse, who is alone and simply reliant on the kindness of strangers?

I have heard that hospitals sometimes keep people deliberately in the 'obs' category because less paperwork for them, and potentially more moey. Probably more often it happens just as a glitch--but disease and emergencies present situations of fear and 

Should not cause the patient and family to watch and guard against such errors.

If your doctor prescribes home health care, it will be paid by Medicare, and will provide hospital bed, wheelchair, ither help. Ask for what you know you need.

Sounds good in the article but the chains snapping up the small community-based hospitals are for profit institutions, competition within region is being reduced or eliminated by the mergers, and some hospitals which prove to be less profitable or duplicative within a given market are either closing outright or being converted to ambulatory care facilities.  This trend could have a decidedly negative impact on health care, especially in lower income/less densely populated areas of the country.

Yes. It is wonderful for the business of health care, but not the people the health care industry is supposed to be serving.

Today was a surprisingly difficult day for me.  Walking through Memorial Park alone during the festival when everyone else seemed to be part of a group.  Seeing all the chairs arranged in groups of two. Standing there by myself as unobtrusively as possible while family groups and couples walked past.  It was very hard.  Maplewoodstock was something that we did together from the very first year and will never be able to do together again.  There are times when it is really difficult being alone.  It is something I have to work on now, not getting used to the aloneness part so much as being able to work through the sadness of it.  Thank you to those of you who came up to me, said hello, asked how I was doing.  It really helped.

Joan, I watched my mother go through this after Dad died, and I am sorry. It must be so, so difficult. maybe it would help to try to find someone to go to these events with? I know...easier said than done.   

so sorry! it is hard to get ambushed on days that you don't necessarily expect to be hard, too! (((joan))) (that's an internet hug)

Joan, i avoid situations right now that i almost know will be triggers for sadness.

The hard ones to me are the ones that catch by surprise...Such as putting a couple on the bus together, then standing alone near the house where we lived together for so many years, and i saw the bedroom window. Such sadness.

In other ways i try to make my current living space more my own....changing a rug and such things. Also i am a writer and am doing a series of pieces about him.  Anything that helps...

joan_crystal said:

Today was a surprisingly difficult day for me.  Walking through Memorial Park alone during the festival when everyone else seemed to be part of a group.  Seeing all the chairs arranged in groups of two. Standing there by myself as unobtrusively as possible while family groups and couples walked past.  It was very hard.  Maplewoodstock was something that we did together from the very first year and will never be able to do together again.  There are times when it is really difficult being alone.  It is something I have to work on now, not getting used to the aloneness part so much as being able to work through the sadness of it.  Thank you to those of you who came up to me, said hello, asked how I was doing.  It really helped.

While renovating my life, I find that there are some objects and activities I cannot part with simply because they have been such a significant part of our time together.  Somehow, a piece of him has become imbued in the fabric of these things and I just can't let them go.  I have given away most of his clothing but could not part with the cardigan sweaters that he wore all the time.  I am still shredding his papers from the 1990s but the table he used as a desk remains untouched.  His favorite chair is still where it always was, though sometimes I sit in it now.  There is a comfort in these objects and if sadness sometimes comes in seeing them, it is mostly a good sadness because it proves to me that his essence is not truly gone.

THAT is how you keep a part of the man you love with you. There are things you should never part with, but you make them a part of your new life as an individual. It becomes a blended existence in my experience. My house now is distinctly me and Jim, but a lot of it now reminds me of the house where I grew up because of how many loved items I have incorporated from my parents.

And I realize that my situation is very different from yours. I am assuming, perhaps incorrectly, that there is overlap between the grief of losing parents and the grief of losing a husband. So feel free to disregard at will.   

joan_crystal said:

While renovating my life, I find that there are some objects and activities I cannot part with simply because they have been such a significant part of our time together.  Somehow, a piece of him has become imbued in the fabric of these things and I just can't let them go.  I have given away most of his clothing but could not part with the cardigan sweaters that he wore all the time.  I am still shredding his papers from the 1990s but the table he used as a desk remains untouched.  His favorite chair is still where it always was, though sometimes I sit in it now.  There is a comfort in these objects and if sadness sometimes comes in seeing them, it is mostly a good sadness because it proves to me that his essence is not truly gone.

Yes, i am finding also that there is comfort in keeping and using things that remind me of him and our time together--a sweater, a pair of boots, his beloved watch. I went through a phase of wearing many if his clothes.  What surprises me is how hard it is to discard some of the little things--pieces of paper in his handwriting, for example.

It has given me pleasure to give some of his things to people whom he loved.

And finally i enjoy something new  like the rug.

As Peggy says it is the blended home, also with things from childhood.  Since husband and I both were 'paper people,' i do need to face the huge amount that will simply have to go.  But i hope to look at it all, bit by bit, know what it is, keep some, say good-bye.

Walkonby said:  Since husband and I both were 'paper people,' i do need to face the huge amount that will simply have to go.  But i hope to look at it all, bit by bit, know what it is, keep some, say good-bye.

I'm still having to face this with some of my parents' things.  And it is compounded by their stuff being in Texas, but me being the one who needs to go through it.  I'm 80-90% done, but there are still some boxes in a storage unit that I can't just toss without going through because I am pretty sure that there are some (at least sentimentally) important things in them.  (I got rid of the obviously unneeded items a long time ago.)

I am going to have to empty a four-drawer filing cabinet that contains the whole history of the house where I grew up. That is going to HURT. For now, I'm just letting it hang out in our garden shed.

Driving update:  My substitute instructor commented negatively on how I made my first turn of the lesson, so off we went to practice.  He had me turning at blind corners on winding roads with the steepest hills he could find.  Talk about getting out of my comfort zone.  Driving to/from Livingston was so much easier.

Sounds like you are almost ready to solo.   

Not really.  Instructor gave me a B- for today's effort.   

What's holding back your progress, Joan?  are you in touch with it?

joan_crystal said:

Driving update:  My substitute instructor commented negatively on how I made my first turn of the lesson, so off we went to practice.  He had me turning at blind corners on winding roads with the steepest hills he could find.  Talk about getting out of my comfort zone.  Driving to/from Livingston was so much easier.

What could possibly go wrong with a turn?  I don't know what these intructors teach.  The hardest part about driving at first is the fear that you get when you sit behind the wheel, and in some instances the fear you feel when the road is particularly challenging with rain or snow, as well as managing to focus on what is really important when there are multiple moving parts:  pedestrians, cyclists, cars.  Making a turn is not high on my list of priorities. I hate it when teachers make negative comments that rob the driver of their courage and confidence. What did he say was wrong with the way you made a turn? 

Where did he have you make all these turns?  the Ss on South Orange Avenue?  those go to Livingston, and you said that was easy, what is more difficult than that?  how did you approach the turns? what were you focusing on?  was there a lot of traffic?  The roads in Chile are full of sharp turns, so sharp that you are in fact making a 180 at times, and you have to make them at 75 mph or someone threatens to kiss your rear bumper.  I think that the most important part of curves is going with the flow of the traffic which is usually a safe speed.  If there is something in the road, the car ahead of you is going to respond to it, so keep a safe distance but go with the speed of the traffic.  Curves have paint or reflectors on the road to stop you from straying into the lane next to you, so establish an angle at which you want to see that line on the road and keep it consistent as much as possible.  Other than that I keep my eyes roaming through the mirrors to try to see anything that could come up that I need to adjust to, but mostly I don't want to fall asleep.  Monitoring keeps me active while driving distances.

When my mom wanted to drive, my dad was giving her lessons, and he really made harsh comments to her.   He didn't want her to learn, because he wanted the car for himself.  Maybe this teacher of yours, Joan, is trying to undermine your confidence, so that you keep paying him for lessons.  My mom never drove my dad's car, but when she bought her own, she was nervous behind the wheel, because he had been such an a-hole with her that she never recovered completely.

Driving is not hard.  You can do it.  If this guy makes negative comments, ask for another instructor.  You don't need anyone who is critical about the way you make turns teaching you how to drive.