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.