Tag Archives: Emergency Room

And You Thought “Mooning” Went Out With Hot Rods…………

In the beginning of 2017, Medicare implemented the new Medicare Outpatient Observation Notice which seems to have the same effect as the old ‘mooning’ we think about from American Grafitti.

You see, MOONing in Medicare (sounds like a love song from Cole Porter, doesn’t it?) means that within 36 hours of entering a hospital, if you will not be admitted, but only kept under  “observation,” they must inform you with a written explanation.  This is the form, if you’d like to see it!

MOON FORM

The problem with this form is the unintended consequences it might have for you, if you are on Medicare, or your loved one, if you are a caregiver for someone who is on Medicare.

If a patient is placed under observation, typically in the Emergency Room, and is never formally “admitted” to the hospital, Part A hospitalization of Medicare does not pay. In other words, you are paying as an outpatient.  For a quick trip to the ER (is there such a thing?) that’s no big deal. After all, the Part A deductible is $1340.00 so you may not even spend that much if you’re only there a few hours.

However, if you are there a few days, and you stay on observation, it is likely that you will start racking up fairly high medical costs with co-pays for every service you are getting. Not to mention any drugs, that likely will not be covered by your Part D while you are in the hospital. It’s complicated, scary and could be costly.

The worst result could be that you are sent to rehabilitation, and because you never met the “admitted to the hospital for 3 days” requirement to have Medicare pay for at least 20 days in that rehabilitation center, you are now responsible for a significant bill coming out of that rehabilitation center. This has happened to people to the tune of thousands of dollars.

So what can you do?

This advice comes directly from this AARP article, which oddly was written before MOON became a regulation and before the MOON form existed. So I have added two of my own suggestions at the end:

Medicare: Inpatient or Outpatient?

  • Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.
  • Ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
  • Ask your own doctor whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
  • If, after discharge, you need rehab or other kinds of continuing care but learn that Medicare won’t cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare’s home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
  • If you go to a skilled nursing facility and have to pay for it yourself, you can try formally appealing Medicare’s decision. When you receive your quarterly Medicare Summary Notice, make a copy and highlight the facility’s charge. Send this to the address provided on the notice with a letter saying you want to appeal Medicare’s decision of noncoverage on the basis that you should have been classified as an inpatient during your hospital stay and not placed under observation. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter.

Additionally,

  •         You can refuse to sign the form. All that does is make the hospital sign it, and make them a bit testy. But it signifies that you do not accept this and hopefully is evidence on Appeal that you were trying to fight the observation status.
  • You can take your patient home. I am not recommending this, especially if the whole reason you are fighting ‘observation status’ is because your patient is very sick and you are certain they will end up in the hospital, a rehab center, or a skilled nursing facility after this event. But one of the problems with Medicare is that they penalize hospitals for re-admissions. So discussing the possibility that you might take your loved one home, that might force a re-admission, may move them to admit your loved one.

Sometimes this feels like the “Art of War,” when dealing with healthcare issues. Being forewarned is being forearmed, as they say. Seems like anything is better than being MOONED!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

Three times is the charm…I don’t think so….

I have spent the last three Friday nights in the hospital emergency room. My brother-in-law has been suffering from pressure wounds, what we lay people would call “bed sores”. Since I’m no nurse and refuse to look at the area between his “gluteal crack and scrotum”, I had no idea it was getting worse, even with care.

On the advice of his home nurse I called the ambulance. My big mistake was I didn’t immediately call 911. You can’t just call the ambulance and say, no one is going to die in the next 10 minutes, so could you come over here and transport?. No, you must call 911 and make it as urgent as possible. Okay, I was a theater major, I can make an emergency if you need me to.

The second Friday night in the ER was because, they sent him home from the hospital too soon even though I begged them to keep him. Within 2 days of his going home and having home nurses and caregivers, and inventors of creative ways to make his wheelchair a place to sit without more bed sores, he was in pain with a draining wound and starting a fever. Five days of IV antibiotics later, they sent him home again.

The very first day the visiting nurse appeared she asked me why he wasn’t sent to rehab. Hmm, good question.

That same night, the third Friday night, he started acting a little ‘off’ around dinner time and within 2 hours, I got a call that he was exhibiting bizarre behavior. This had happened once before when he had a massive infection. I gave the home caregiver the pleasure of calling 911 and using her theatrics to get an ambulance poste haste (that’s acting talk for hurry up, someone’s sick but isn’t going to die in 10 minutes).

And this is where it gets crazy.

The first half hour in the ER, he’s got two technicians on either side of him with his arms out trying like hell to get a drop of blood out of him. He looks like a crucifixion. The entire time he’s saying in a monotone: “Ow.”

Like a hundred times: “Ow.”

“Where does it hurt?” I ask him.

“Everywhere,” he says.

That exact conversation continues for the next three hours.

After two hours of “Ow”, they tell me he’s third on the list for a CT-Scan. He starts to get a little crazy now. He’s thrashing around and my Mom and I are holding down his arms because he has IV lines in his hands and we don’t want him to accidentally rip them out. He’s already been crucified once.

Then he gets louder and now he’s saying: ” I can’t” and “Oh please” and “Ow” and we try to reassure him. He is thrashing and fighting pretty wildly now.  I have asked for a pain pill and I’m just about to pull a “Terms of Endearment” Shirley MacLaine mother of all hissy fits, when the nurse comes in with the CT-Scan tech behind her. She tries to give L a pain pill, but he won’t swallow water. The CT Scan guy disappears figuring he ain’t goin’ anywhere till he calms down, and then the Nurse high tails it all around the ER looking for CT guy to get his ass back here and take L for a scan.

Somehow they successfully scan him. NOW because all tests of urgency have been done, and there is no concern that a pain killer IV will harm him, the Nurse hunts down the doctor….who we still have not seen or talked to…..and comes in with some miracle drug that knocks him right the hell out in 60 seconds flat.

It is now almost 2 A.M. We have been there for more than 3 hours. He is finally resting, calm and not in any obvious distress. We go out to the Nurses’ station to see if they have any sense to confirm that he will be admitted. I answer all their questions. One of the doctors says let’s go back to his room so I can see if I have any more questions. I’m thinking she wants some HIPPA privacy rather than discussing this in the open hallway.

My mom and I walk into his room. He is resting so comfortably that we both let out a huge sigh of relief.

What is the first thing this doctor does?

She gently goes over to his bedside, looks down at him, puts her hand on his shoulder, shakes the hell out of him, pulls his eyelids up and yells: ” L! CAN YOU HEAR ME? L! CAN YOU OPEN YOUR EYES?”

My mom and I just look at each other and go “Ow” and walk out of the room……good luck with that Dr. Nutjob.

 

You just have to Laugh………..

Cathy Sikorski