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Stop playing cruel word games with senior citizens’ Medicare



Published: Fri, February 14, 2014 @ 12:00 a.m.

Consider the plight of 87-year- old Julia Matthews of Toledo, who got zapped with a $61,000 bill after entering a nursing home for rehabilitation and aftercare from a disabling attack of gout. After spending six days in a hospital, she and family members had assumed her Medicare health insurance would kick in to cover all or most of the nursing-home expense.

Their assumption — and those of about 600,000 other Medicare beneficiaries in similar circumstances last year — were sadly flawed. Unfortunately for the Matthews and others, the charges were absolutely legal and resulted from a glaring and heartless loophole in the law governing the respected health-insurance program for American senior citizens.

Democrat U.S. Sen. Sherrod Brown, alas, has come to the rescue. The senior senator from Ohio has introduced into Congress “The Improving Access to Medicare Coverage Act” to protect seniors such as Matthews from outrageous medical costs they cannot afford.

Here’s the crux of the dilemma: Under revised Medicare policy enacted last year, a beneficiary must have an “inpatient” hospital stay of at least three days before the government insurance program will kick in to cover post-hospitalization skilled nursing care.

Patients who receive hospital care on “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days. They also face a double whammy of shockingly sky-high bills by the hospital to cover the difference in reimbursement it receives for inpatients and those on observation status.

Brown believes it’s time to erase the semantics hogwash. A hospital stay for “observation” and tests oftentimes differs precious little from an “inpatient” hospital stay for recuperation from illness. In laymen’s terms, an overnight hospital stay translates into an admission as a “patient in” the hospital.

“When seniors are transferred from a hospital to a nursing home for further care, they should be able to focus on their recovery instead of technicalities that could lead to sky-high medical bills,” Brown rightly argues.

Brown’s proposal, Senate Bill 569, has garnered bipartisan legislative and widespread professional support, would amend Medicare law to count a beneficiary’s time spent in the hospital on observation status toward the three-day hospital stay requirement for skilled nursing care. It also would establish a 90-day appeal period after passage for those who have a qualifying hospital stay and have been denied skilled nursing care after Jan. 1, 2013.

AMA, other support

An impressively large set of medical, hospital and other organizations fervently support Brown’s legislation. Among them are the American Medical Association, the American Nurses Association, American Medical Directors Association, the American Association of Retired Persons and many others.

George Semer, director of care coordination for Humility of Mary Health Partners that operates St. Elizabeth and St. Joseph hospitals in the Mahoning Valley, counts himself among that expansive cadre of supporters. He said Brown’s legislation would help ease the transition from acute hospital care to a lower level of care in nursing homes or assisted-living facilities and ease undue stress of unexpected astronomical bills.

“The three-day stay requirement should be eliminated ... the sooner the better,” Semer asserted last week.

We agree. But if the current and sizable bloc of obstinate Republican U.S. senators and representatives fails to see the humanitarian logic of Brown’s bill and fails to act to quickly to approve it, then the Cleveland senator should rally his prestigious and powerful collection of allies to lobby Medicare administrators forcefully to make the policy change on their own.


Comments

1formerdemliberal(182 comments)posted 5 months, 1 week ago

Quotations have been placed around various unnecessary words that clearly point this "opinion" toward Democratic interests while using boilerplate characterizations of all Republicans as insensitive and cruel.

"cruel word games" (Who is "cruel"?)

"a glaring and "heartless" loophole (who created the loophole?) in the law governing the "respected" health-insurance program for American senior citizens." (You are calling a program that is contributing to the future bankruptcy of the US "respected"?)

"Under "revised" Medicare policy "enacted last year" (By whom? Obama Medicare administrators? The term "enacted" implies that this "cruel and heartless" loophole was enacted by Congress with the approval of a Democratic majority US Senate.)

"Brown’s proposal...has garnered "bipartisan" legislative...support." (If bipartisan support exists for closing the loophole, why bash "obstinate" Republicans?)

"But if the current and sizable bloc of "obstinate" Republican U.S. senators (a senate minority) and representatives fails to see the "humanitarian logic" of Brown’s bill and fails to act to quickly to approve it..." (Sherrod Brown for sainthood? Your facts should speak for themselves.)

"...then the Cleveland senator should rally his "prestigious" and "powerful" collection of allies to lobby Medicare administrators forcefully to make the policy change on their own." (Right out of the Obama executive order playbook. Just who are Sen. Brown's prestigious and powerful allies? Labor unions? The AARP who sold its soul to sell Obamacare insurance to the detriment of Medicare funding and is now basically an insurance company and not a senior citizen advocacy group? Hospital administrators who want their revenue to increase regardless of the source (working class taxpayers) while outsourcing their responsibilities to nursing homes?) Attach some names to your "groups" so that readers can genuinely determine the validity of your claims.

This "editorial opinion" clearly has an agenda towards Democratic viewpoints and some questionable vitriol against Republicans. The generalizations, biased descriptions, and single example (commonly used by politicians) that already appeared in a 1/21/2014 Toledo Blade article appears to demonstrate a laziness of independent research and looking at both sides of this issue.

I don't disagree with the article premise of plugging a legitimate insurance loophole. What is objectionable is the use of wording that clearly favors Democratic interests while failing to adequately identify exactly what group was responsible for the "cruel" loophole and why?

This "editorial opinion" could have just as easily been written by Dave Betras, the comedy team of Betras and deSouza, Senator Brown's office, or the Ohio Democratic Party? Shouldn't the Vindicator editors hold themselves to a higher standard of journalistic integrity in formulating their views on a subject?

In this case, apparently not.

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2Photoman(993 comments)posted 5 months, 1 week ago

When a patient is told by a doctor that he is going to be admitted, neither the doctor or anyone else bothers to explain the differences in the type of admission or the possible resulting costs. Patient beware!

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3YtownParent(276 comments)posted 5 months ago

Agree with about the tone of this so-called "opinion" @formerdemliberal. Brown's bill does nothing to stop hospitals from "playing cruel word games". His bill would only "amend Medicare law to count a beneficiary’s time spent in the hospital on observation status toward the three-day hospital stay requirement for skilled nursing care. It also would establish a 90-day appeal period after passage for those who have a qualifying hospital stay and have been denied skilled nursing care after Jan. 1, 2013."

All it does is allow the nursing facilities to get payment from the state, aka Medicare for a post "observational status" hospital stay. It's a monetary gimme to the nursing homes that would otherwise be left trying to squeeze blood from the turnip of empty seniors wallets. It does nothing to alleviate the hospital bill they get for those "observational visits".

If Brown and his supporters truly want to help seniors who are getting slammed by unexpected medical bills, then table this bill and introduce one that completely strips the adjectives from hospital stays. Make hospitals and medicaid call a hospital stay a hospital stay. Won't happen. Mark Twain said of adjectives: "when in doubt leave it out." But there is no doubt for the Brown and his campaign contributors that an adjective before a hospital visit is worth alot of money.

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