November 2013
October 30, 2013

Retirees help change hospital policy

Author: By Liza Frenette
Source: NYSUT United

After steadfast advocacy by NYSUT retirees, a new state health care law requires hospitals to be more accountable. Under the observation services act, hospitals must now provide patients notice within 24 hours of being admitted whether they are on observation status or inpatient status, and what the implications are.

The growing trend of placing patients on observation status is confusing to patients who are actually spending nights in a hospital but have been unknowingly tagged as "outpatients" or "observation." Services an observation patient may need at a skilled nursing facility after a hospital stay are not covered by Medicare. Observation status also means Medicare patients in the hospital pay more for services such as X-rays, drugs and lab tests.

"The distinction between inpatient and outpatient/observation status is a vitally important matter," said Kathleen Donahue, NYSUT vice president who oversees health care. "Medicare beneficiaries not informed of their status have been hit blindly by sometimes exorbitant bills upon discharge. For retirees on a fixed income, these medical costs are prohibitive."

Medicare regulations state that patients in observation status do not qualify for the three-day requirement needed for Medicare to cover a skilled nursing facility stay.

The new state law is a first step in protecting those on Medicare. A longer push on the federal level is calling for changes that would make an observation visit count toward the requirement for covered treatment at a rehabilitation facility.

NYSUT and the AFT encourage both in-service and retired members to contact Congressional representatives and urge them to pass the Improving Access to Medicare Coverage Act, which is being sponsored by Sen. Chuck Schumer, D-NY.

United Federation of Teachers retiree Thalia Cassuto won't stop her advocacy until the federal law is passed. Her husband, Ike, who broke his pelvis, was hospitalized and then brought to a skilled nursing facility. He was surprised when he learned he would have to pay thousands for services because he was put on "observation" in the hospital.

"There needs to be legislation from Congress saying that any stay in the hospital that lasts three days means that any rehabilitation you require is part of your Medicare coverage," said Thalia Cassuto.