Doctor a nd med students in a hall studying

What You Need to Know About Observation Status

As of August 2015, President Obama signed a bill requiring hospitals to notify Medicare patients when they are receiving observation care but have not been admitted. Even with the bill, it’s still good to ask questions and be proactive no matter the situation when communicating with a healthcare provider.


Do you know about observation status? You probably should.

Many Medicare patients and their caregivers have been hit with costly bills as a result of being placed under what hospitals refer to as “observation status.” Observation status is supposed to be no longer than 48 hours with the purpose of giving the doctor time to determine what exactly is wrong with the patient. The problem with this is that the patient is often unaware because it looks like a regular old admission into the hospital. Patients are taken to a hospital room where they may remain for days and when discharged to a rehabilitation facility or prescribed certain prescriptions, they are responsible for the entire bill. There is no requirement by Medicare to inform the patient that they are under observation status but some states such as New York are putting policies in place.
Medicare requires an admission over three midnights in the hospital to then reimburse for admission into a rehab or skilled nursing facility. The key word here is “admission.” Patients are staying in the hospital for these three nights but unaware they are under observation status rather than an admission. The top reasons patients are under “observation”? Chest pain, digestive disorders, fainting, nutritional disorders, irregular heartbeat and circulatory problems. We all know these are fairly common maladies for seniors. So, what can you do to avoid the “observation” surprise?


Ask questions.

Ask the staff providing care to you or your loved one if they are under observation status, especially once they have been moved out of the emergency department and placed in a hospital room or if more than eight hours have passed since you arrived at the hospital. If you get the brush off from one staff member, ask another and another until you get some answers. This is another occasion where having a family or professional advocate is so helpful. The last thing you want to be doing when you are feeling poorly is spending precious energy trying to get answers.


Think like Cinderella.

Don’t turn into a pumpkin. Get into the ER before midnight. Some studies have suggested physicians are more likely to admit patients they believe will be in the hospital for more than two midnights if they can assess early.


Get your primary provider involved.

If the admitting physician at the hospital is dragging their feet, contact your primary provider and ask them to speak to the admitting physician to discuss your medical issues and history. Your primary physician will have insight and be able to help shed some light to determine if you can be discharged or need to be admitted and even if rehabilitation may be necessary.


Get help.

If you are one of the many patients who are surprised that they were place under observation status and now face a costly bill, you can contact an elder law attorney to help you try to get some reimbursement but it can be a difficult battle. It is far better to ask questions while you are still in the hospital and be proactive and engaged in your care. The Center for Medicare Advocacy offers a self help packet with more information.