by – Sheri de Grom
The telephone startled her. She didn’t recognize the number but today had to be the day she’d break her rule and answer. The official sounding voice was one she’d never heard before. Without preamble, he told her his name and confirmed hers. He also confirmed her relationship to a patient he had in the emergency room of the local medical center.
Before she could ask questions, the voice on the phone was gone. She had questions: what, how, when, why an ambulance. Thank God she’d already had her shower and hurried to find jeans, sweater, run a comb through her hair, grab her purse and she was gone. Gone to the emergency room. Sheer panic had set in and she moved into auto-pilot.
How could it be? He’d been his usual cheerful, energetic self as he’d left the house that morning.
When she arrived at the Emergency Room (ER) the staff explained that her husband had passed out at work and so far, there was no known reason why.
A clerk interrupted, “Do you have your insurance cards with you?” Payment is at the front of every hospital’s mission in today’s economy.
She was advised that the specialists were running tests and she could have a seat in the waiting room.
What would happen to her if she screamed, “No, the only thing I want is my healthy husband, the man I love.” That wouldn’t happen now and she settled into a hard plastic chair in defeat.
It seemed she’d waited hours but it’d actually been less than two. Two hours with her guts turning over and over and a hammer in her head that refused to stop. It banged her front temporal lobe a million times a minute. She was sure of it.
Finally, someone from the ER staff asked her to join them and said, “The doctor will speak with you now.”
Unfortunately, she learned nothing other than her husband passed out at work, numerous tests had been completed, and nothing conclusive explained the incident. He was now resting but the doctor thought he’d be more comfortable if her husband stayed a while longer to ensure his stability.
She nodded her head yes and signed more papers. She didn’t want to take chances and agreed to a new strategy in emergency care (although she wasn’t aware that’s what was happening).
This new movement in emergency care is shifting the cost of expensive emergency care rates away from hospitals, Medicare, Medicaid and all commercial insurance companies. Patients are classified as ‘short-stay emergency department inpatients.’
National data collected by researchers at the School of Medicine at Perelman in December 2013, suggested that keeping selected patients under observation in a dedicated hospital unit with defined protocols could yield hundreds of millions of dollars in cost savings for everyone but the patient. More often than not, the patient doesn’t understand the hidden cost of being transferred to observation status until a large charge appears on their statement.
The ‘kept for observation’ status has been a topic of controversy for Medicare patients for years, and in 2012 an investigation by the Department of Health and Human Services Inspector General found inconsistency between hospitals in how they determined whether a patient was admitted or kept under observation. For Medicare patients, such ‘observation stays’ are associated with higher out-of-pocket care costs and a lower likelihood that nursing home care will be covered.
Please be aware, any time you or a loved one is moved from a dedicated Emergency Room Department to an Observational Unit, there will likely be a reduced amount in what any insurance company is willing to pay.
This shift in cost for emergency care affects all patients. It is not exclusive to Medicare and Medicaid. I encourage you to read your health insurance policy carefully.
Any stay in a hospital beyond 24 hours is considered an admission to your insurance company but you may remain on observational status per the hospital. It is a catch-22 for the individual responsible for the account.
Many same-day surgeries result in observational status (i.e. the recovery room). However, if surgical complications or recovery from anesthesia occur, the surgery patient is placed in out-patient observation status.
Please be aware, any time you or a loved one are moved from the dedicated Emergency Room Department to an Observational Unit, your cost may be higher than expected.
The entire financial burden could be yours.