Registered nurses in California say the time has come to put limits on the hospital shell game of parking patients in “observation” beds as a substitute for inpatient admission — with significant health and cost risks for patients.
In the past six years, the number of patients held in observation has risen by 88%, with many staying 48 hours or more.
In testimony to the Senate Health Committee earlier this year, Kaiser Permanente RN Kathy Donahue noted that “patients that historically have been admitted with their presenting complaint or diagnosis are now being placed in observation status and remaining there for as long as currently legally possible.”
“Many of these patients are extremely sick,” Donahue noted. “They are now there with much more serious symptoms such as chest pain and cardiac complaints. Make no mistake, being a patient in an observation unit is currently extremely unsafe.”
Why the explosion? The reason, as so frequently happens in the hospital industry, is to protect profit margins.
Observation care, even when within a hospital’s walls, is considered an outpatient service, typically with fewer public oversight rules, less staffing and no Medicare penalties if the patient is re-admitted within 30 days, as now often occurs.
Hospitals are not required to tell patients they are in an observation bed, and are thus responsible for costs Medicare doesn’t cover, including higher copayments for physician fees, other hospital fees, or the inflated charges hospitals impose for certain medications, especially those for chronic conditions.
Further, a patient sent from a hospital to a nursing home must have been have been an in-patient for three consecutive days for Medicare to pay the hefty costs. Time in an observation bed does not count.
Noting these problems, Medicare officials last fall announced a new rule requiring hospitals to admit patients for at least two nights if they thought full hospital care was likely needed. But the hospital industry has vigorously lobbied against the rule leading to a current moratorium.
CNA this year sponsored SB 1269 to direct hospitals to limit patient observation stays to 24 hours and meet the same staffing standards as regular hospital units. It would also require hospitals to inform patients when they are being held in an observation bed.
CNA opposed a hospital-backed bill, SB 1238 because of loopholes that could continue to leave patients in limbo while waiting for needed hospital admission to the appropriate setting.
While SB 1269 has been stalled in committee due to hospital industry opposition, we fully intend to continue to fight for it this year or next.