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
No One Ages Well Alone
Help at Home
November 2016 Family Caregiving
October 2016 Annual Report
September 2016 Corporate Healthcare
Is Your Home Age- Friendly?
May 2016 Director's Message 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 60 Is the New 60
April 2015 - Spring
March 2015 - 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
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!
Am I Old?
Aging In America May 2010
Volunteering April 2010
Spirituality March 2010
Encore Careers January 2010
Hiring Home Care
Annual Giving by
Flu Pandemic 2009 October 2009
Healthy Memory, Healthy Mind
A Personal Perspective on Caregiving
Wei Ji: Crisis, Danger and Opportunity
Write your own obituary
Hope and Vision in Challenging Times
Medicare Changes 2008: Take A Look!
Scams, Frauds and Rip-offs November 2008
Engaged Retirement: Beyond Financial Planning
Finding Rhythm and Purpose
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?
Get Moving with FitRhythms™!
My Condolences January 2008
What Are Social Services? November 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