This Will Teach Little Old Ladies to Brush Up On Medicare’s Rules

So here’s a sad story about medicine and the law. Sarah Mulcahy was 96 years old when she suffered a bad fall. The pain was so severe that she became incontinent and nauseous. After going to the emergency room, she was hospitalized and spent three nights at Manchester Memorial Hospital in Connecticut. While there, she was X-rayed, CT scanned, hooked up to an IV, treated with an incentive spirometer, and given compression cuffs to prevent deep vein thrombosis. After being discharged, she went to a skilled nursing facility (SNF) to recuperate. She stayed there for more than three months at a price tag of about $30,000.

Fortunately, Medicare covers the costs of SNF care for patients who first spend at least three days as a hospital inpatient. (This is known in the lingo as the “three-midnight rule.”) Unfortunately for Ms. Mulcahy, however, she was never technically admitted as an inpatient to Manchester Memorial. Instead, the hospital had put her on “observation status,” an ill-defined halfway house for a patient who’s too sick to go home but who might not be sick enough to need the full range of hospital services. Because Ms. Mulcahy wasn’t ever an inpatient, Medicare wouldn’t cover her subsequent SNF stay.

So she sued and lost. And then there is this:

The bad news for Ms. Mulcahy is that financial incentives have recently been pushing hospitals to put more and more patients on observation status. (More from the Incidental Economist)

Comments (10)

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  1. Perry says:

    Looks like an effort to prevent fraud and abuse has resulted in ….fraud and abuse.

  2. Devon Herrick says:

    I’ve worked in a hospital and I wasn’t aware of this.

  3. ColoComment says:

    Were I Ms. Mulcahy, I’d appeal that “technical” status on the basis that the various treatments received during the hospital stay amounted to far more invasive and intrusive treatment than mere “observation,” and that classifying my stay as the lesser “observation” status was either error or deliberate mislabeling (for whatever reason) that deprived me of the Medicare coverage to which I was entitled.

    It would be worth a try, anyhow.

  4. Linda Gorman says:

    Yet another reason why people need to be liberated from Medicare with premium support.

  5. Chris says:

    Does the average citizen really need to be a lawyer or expert in health care to not get taken advantage of?

    Give us common folk a break…

  6. Doris says:

    The three-midnight rule, I’ll just have to remember that!

  7. James says:

    The elderly always are taken advantage of and without any effort at times. They do not know what to say what they need for care and just go along with all recommendations and care. By the time it is all over with, they get the bill and had no idea it would be that high.