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FOR IMMEDIATE RELEASE: February 20, 2013

SCHUMER: MEDICARE’S ‘OBSERVATION STATUS’ FORCES SENIORS TO PAY THOUSANDS EXTRA FOR REHAB THAT ARE NOT REIMBURSED – SENIORS ARE LEFT HIGH & DRY, UNABLE TO PAY HUGE BILLS POST-HOSPITAL STAY



Schumer’s New Plan Would Change Three-Day Requirement & Allow Time Spent In ‘Observation’ To Count Toward Medicare-Covered Rehabilitation – Saving Seniors Huge Costs

Schumer Highlighted That ‘Observation’ Stay Cases Are Skyrocketing In Hospitals Across the Capital Region And Country, As Hospitals Comply With Flawed Medicare Law

Schumer Will Join Ike Cassuto Who Was Put Under ‘Observation Status’ At the Hospital– For Days–After Breaking His Pelvis, Meaning Medicare Won’t Cover Nursing Home Recovery Care, Which Can Cost Thousands

 

Today, at St. Peter’s Hospital in Albany, U.S. Senator Charles E. Schumer joined Capital Region senior citizens and hospital executives to push his plan to change the Medicare law, so that elderly patients are not charged unfairly for receiving needed nursing home care after being hospitalized. Schumer noted that “observation” stay cases in hospitals, when the elderly individual is not technically an inpatient, have been on the rise in recent years, costing America’s seniors thousands of dollars in medical bills. Currently, Medicare will only cover post-acute care in a skilled nursing home facility if a beneficiary has three consecutive days of hospitalization as an inpatient. Under Schumer’s plan, the Improving Access to Medicare Coverage Act, “observation” stays will be counted toward the 3-day mandatory inpatient stay for Medicare to cover rehabilitation post-hospital visit.

 

For example, Mr. Ike Cassuto recently broke his pelvis and spent four days at St. Peter’s Hospital. In accordance with current law, St. Peter’s listed him under “observation status” because no operation or procedure was performed. The consequence of this meant that Medicare will not pay for his 3-weeks in rehab that followed his hospital stay. Schumer emphasized it is the flawed Medicare law which is costing Capital Region seniors thousands of dollars.

 

“In recent years, there’s been a huge uptick in elderly patients under ‘observation status’ at Capital Region hospitals – and it’s leaving seniors high and dry and hospitals no better off. A flawed Medicare law is to blame, and I have a plan to change that, so hundreds of thousands of seniors, like Mr. Cassuto, are not hit with huge rehabilitation bills after a lengthy hospital visit. This new Improving Access to Medicare Coverage Act would allow senior citizens to count time spent under this ‘observation status’ towards Medicare-covered rehabilitation. If you are holed up in a hospital bed for days on end, it shouldn’t matter what your billing status is, and this plan will save Capital Region seniors thousands.”

 

Schumer was joined by James K. Reed, President & CEO of St. Peter’s Heath Partners; Mr.& Mrs. Ike Cassuto; James Barba, CEO of Albany Medical Center; Gail Myers of Statewide Senior Action and representatives from AARP. Schumer highlighted Mr. Cassuto’s recent case, and explained that this is one example of hundreds of thousands. The number of observation cases has been on the rise in recent years, a consequence of policies meant to reduce Medicare expenditures. According to the Albany Times Union, St. Peter’s Hospital, serving the Albany community since 1930, has reported that observation cases have nearly doubled in the past three years, with 2,560 cases in 2009 and 5,000 in 2012. This can lead to massive bills – in the tens of thousands of dollars – that senior citizens must pay for rehabilitation and nursing home care post-hospital visit.

 

Schumer vowed to fight for the bipartisan Improving Access to Medicare Coverage Act to address the flawed Medicare law. Currently, Medicare will only cover post-acute care in a skilled nursing facility if a patient has three consecutive days of hospitalization as an inpatient, not counting the day of discharge. Because of the uptick in observation cases, patients are enduring lengthier hospital stays in observation status and may unknowingly be treated under outpatient observation status for the entirety of their hospital visit. Under Schumer’s legislation, observation stays will be counted toward the 3-day mandatory inpatient stay for Medicare coverage of skilled nursing facility services after a hospital visit. The Improving Access to Medicare Coverage Act of 2013 would amend title XVIII of the Social Security Act. Without being involved in billing technicalities between the hospitals and Medicare, Schumer’s plan would ensure that patients 65 and older are eligible for coverage for their rehabilitation services, as long as they are in the hospital for three days.

 

“Observation stays” are specific, clinically appropriate services that treat and assess a patient in a hospital while a decision is being made as to whether patients will require further treatment as hospital inpatients, or if they are able to be discharged from the hospital. Hospitals, like St. Peter’s, are following a flawed Medicare law in their treatment of many patients above 65 years old. In fact, Schumer noted, that hospitals are reimbursed less from Medicare for the treatment of patients under “observation” status than those that are inpatient. Hospitals also devote a significant amount of time and money to assuring that patients are properly classified as inpatients or outpatients.

 

Isadore “Ike” Cassuto’s case is among the hundreds of thousands of elderly Americans who have been placed under “observation” status during a hospital stay, and who now face medical bills that Medicare refuses to cover for rehabilitation services. Mr. Cassuto came to St. Peter’s Hospital after breaking his pelvis and was a patient for four days, but the hospital had him under observation without admitting him as an inpatient. Mr. Cassuto then underwent three weeks of rehabilitation, which was not covered under his Medicare plan, leaving him with $6,000 in medical bills.

 

“We thank Senator Schumer for his leadership on legislation that will promote fairness for Medicare patients who need rehabilitation following a hospitalization. Because of the uptick in the number of Medicare observation status billing codes throughout our state, NY StateWide Senior Action Council has developed a Patients’ Rights Toolkit, available at 1-800-333-4374.  We encourage Medicare patients to ask about their status so that they can make informed decisions regarding their discharge plan, and uphold their rights to care through the appeals process when needed. Patients should not be forced to pay out of pocket for otherwise covered Medicare services due to institutional billing issues,” said Gail Myers of the NY StateWide Senior Action Council.

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