Why aren’t the hospitals admitting people anymore?
You have a fall, go to the emergency room and learn you have fractured your pelvis and require a few stitches. You have a lot of pain so the physician decides to “keep you a few days.” This doesn’t mean you will be “admitted” to the hospital. This doesn’t mean you will have the required 3 midnight hospital stay to get the skilled rehabilitation stay to recover. At least not covered by Medicare or most other medical insurances. Surprise, you find yourself in “observation status.”
Why don’t the hospitals admit you anymore? Medicare made some major changes that affect how a hospital admits or doesn’t admit you. In simple terms, if the physician thinks he can treat you, no matter the medical reason, in less than 48 hours you are observation. It is the rules. Not a “mean” hospital. It will affect the percentage of coverage for your stay and the cost of the medications they administer while you are there. It will affect what you qualify after your stay.
What can I do to help myself should this happen to me? First of all, you can’t “trick the system.” The physician can be fined and the hospital committing fraud if they change your medical status without medical cause. What you can do is plan ahead and/or get a help from a specialist at CayCare.
- Set aside money in case you need care or placement from a medical event or injury. Plan for $300/day for at least 30 days as short or “respite” stays can cost more then a long term placement.
- Have a specialist evaluate you and your long term care plan BEFORE you need it.
- Designate someone you trust to help you should you need care unexpectedly.
- Have an advocate, preferably a professional that is not a part of the hospital. This professional will be sure to help support what you need while understanding the system