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Director's Message

Observational Stay

Many of you know that under the Affordable Care Act, hospitals will be penalized for having too high a rate of re-admissions. Hospital systems have responded with several initiatives to reduce readmissions. One of these is establishing Transitions of Care, currently being piloted at PHCS and RWJ Medical Centers with grants from the RWJ Foundation. This program connects people being discharged with certain diagnoses to a Transitions counselor who will meet with them both in the hospital and once they return home to ensure that they understand and follow the doctor’s orders and medication regimen.

Hospitals are also trying to reduce negative outcomes and readmissions by reducing hospital-acquired infections. If you have taken a tour of the new PHCS or Capitol Health medical centers, you may have noticed how much emphasis was put on various technologies and practices for reducing transmission, such as hand-washing stations and special fabrics. You may also notice more use of masks by staff.

But I am concerned about one practice that I heard about last year. This involves placing a person on “observation stay” rather than admitting them to the hospital. Initially my concern was that a person who had been hospitalized for one condition (such as an infection) would be more likely to be put on observation if returning for either that condition or something unrelated (such as a fall/hip fracture). There are several implications of observation status, including:


The hospital stay may not be covered by Medicare A. Medicare B only pays 80% and has no cap, thus potentially higher costs for the patient who does not have supplemental insurance.
Supplemental insurance rates will increase if they shoulder more of this cost.
A person must have a 3 night admission for Medicare to pay for Rehabilitation or Skilled Nursing Facility care to regain strength and capacity after the hospitalization (otherwise the cost is fully on the patient).

Observation stays were intended for situations where it is unclear whether a person should be admitted, and should be for less than 24 hours. Medicare is looking at claims more closely and trying to ensure that admissions meet their criteria. Hospitals are also being more cautious, as they will not get paid for improper admissions.

In the last 2-3 months, I have seen a sudden increase in the number of people who are reporting to me that they were put on observational status. Neither they nor their physicians were aware of these implications. I would like to hear your experience and verify my understanding of this situation. If you are faced with this situation, make sure you understand your status and what it means for you.

To read more, search “observation stay” on the internet; there are reports by Medicare(CMS) and Wall St. Journal.

 


On a related note, Medicare is also exploring reducing costs with a program called Patient Centered Medical Home Care. It is a team-based health care model led by a physician with a strong emphasis on care coordination to improve health outcomes. Specially trained staff in the doctor’s office provide education, follow up, and help navigating the healthcare system. Medicare reimburses these practices at a higher rate which acknowledges a higher cost to the practice, while expecting that the overall cost to Medicare will be lower if there is better preventive and follow-up care. We work with some of these care coordinators and would like more of them to know about PSRC services. Please be our ambassadors if your physician is in a PCMH practice!

We will try to schedule Lunch & Learn speakers on these programs in the coming months.

Susan W. Hoskins, LCSW

Previous Messages

October 2017: HomeFriends Celebrates 30 Years!

September 2017: Annual Report

July/August 2017: Preferred Caregivers: Daughters

June 2017: Cues & Clues

May 2017: Recharging

April 2017: GrandPals Celebrate 20 Years!

March 2017: Multi-generational Households

February 2017: No One Ages Well Alone

January 2017: Help at Home

December 2016: Gratitude

November 2016: Family Caregiving

October 2016: Annual Report

September 2016: Corporate Healthcare

July/ August 2016: Strategic Planning

June 2016: Is Your Home Age- Friendly?

May 2016 Part 2 : We Need Your Help

May 2016 Part 1: Going Solo

April 2016: Volunteering

March 2016: Partners In Caring

February 2016: PSRC's Strategic Plan

January 2016: Hope

December 2015: Gratitude

November 2015: Helicopter Children

October 2015: Is Princeton An Age Friendly Community?

September 2015: Annual Report

July & August 2015: Family and Community

June 2015: A Gift that Keeps Giving

May 2015: Is 60 the New 40

April 2015: Spring

March 2015: On Being Mortal

February 2015: Mentoring

January 2015: Winter Blues

December 2014 - Leaving A Legacy

October 2014 An Age Friendly Future

September 2014 Annual Report

July - August 2014

June 2014 - Romance After 50

May 2014 - Your Virtual Estate

April 2014 - Memory and Forgetting

March 2014 - Aging in Community

Observational Stay

February 2014 - Family Caregiving

January 2014: Attitudes about Aging

December 2013 - Giving

November 2013 - Healthcare Marketplace

October 2013 - Annual Report 2013

September 2013 - Total Brain Health® Fair

July - August 2013 My cat, My Father and Me

June 2013 - Age Friendly Communities

May 2013 - Navigating a Changing HealthCare Landscape

April 2013 - Becoming Visible

March 2013 - Navigating Life’s Transitions

February 2013 - Partners in Caring Princeton

January 2013 - Men as Caregivers

December 2012 - The Safety Net

November 2012 - Going Solo

October 2012 - Documenting Your History

September 2012 - A Journey of Transformation

July - August 2012 - Gratitude & Moving

June 2012 - Diversity

May 2012- Aging in America

APRIL 2012 - TEN YEARS

March 2012 - Patient-centered Care

February 2012 - Can you Spare an Hour?

January 2012 - Challenges & Opportunities

December - Are you Prepared for Emergencies?

November - We need YOU!

October - Chocolate for Memory

September- Looking Back and Looking Forward

July - August 2011; Ageism

June 2011 - Accessibility

May 2011 - Paper retention

Knit Wits, April 2011

Lessons and Legacies, March 2011

Independent Living February 2011

Home Safety January 2011

Witness to my Life December 2010

Elections, benefits and open enrollment November 2010

Retire in 3D!

Strategic Planning September 2010

Am I Old? July 2010

Memory Clutter June 2010

Aging In America May 2010

Volunteering April 2010

Spirituality March 2010

Estate Planning February 2010

Encore Careers January 2010

Hiring Home Care December 2009

Annual Giving by Sharon Naeole November 2009

Flu Pandemic 2009 October 2009

Healthy Memory, Healthy Mind September 2009

A Personal Perspective on Caregiving July/August 2009

TRANSPORTATION May 2009

Wei Ji: Crisis, Danger and Opportunity April 2009

Write your own obituary March 2009

Hobbies February 2009

Hope and Vision in Challenging Times
January 2009

Medicare Changes 2008: Take A Look! December 2008

Scams, Frauds and Rip-offs November 2008

Engaged Retirement: Beyond Financial Planning October 2008

September 2008 Caregiver Dilemmas

Finding Rhythm and Purpose July/August 2008

Spring Cleaning II June 2008

V + OA = ER (Volunteering + Older Americans=Engaged Retirement)May 2008

Spring Cleaning April 2008

Have You Had the Talk Yet? March 2008

Get Moving with FitRhythms™! February 2008

My Condolences January 2008

Advocacy December 2007

What Are Social Services? November 2007

Sensitive Topics October 2007

Plan for the Future September 2007

The Up-side of Aging Summer 2007

Volunteering June 2007

Strategic Plan May 2007

National Conference on Aging: Let's ReThink Aging April 2007

Brain Health March 2007

Resiliency February 2007

Transportation January 2007

Season of Giving December 2006

Medicare Part D November 2006

April Hill McElroy October 2006

Civic Engagement September 2006

Change June 2006

White House Conference on Aging May 2006

Hearing Loss April 2006

GrandPals March 2006

Lets Talk February 2006

Eldertopia January 2006

Hoarding December 2005

Annual Report: November 2005

Are You Prepared? October 2005

Planning Ahead October 2005

Watch Your Language September 2005

Medicare Part D Summer 2005

Sue Tillett June 2005

The End of the Journey May 2005

Clutter March 2005

New Dietary Guidelines February 2005

Transitions January 2005

Funding December 2004

Caregiving November 2004

Civic Engagement with GrandPals October 2004

A New Look September 2004

Safe Driving Summer 2004

Food Safety June 2004

Communication June 2004

The Challenge of Giving Care May 2004

Seniors On The Move April 2004

Depression March 2004

McGreevey February 2004

Medications January 2004

Random Acts of Kindness December 2003

Civic Engagement November 2003

Reverse Mortgages Oct 2003

Emergency Preparedness, Jan 2003


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