Courtney weighs in on Medicare rule that leaves some patients paying bill

Hartford — An oddity in Medicare rules that is leaving some elderly patients and their families with hefty bills for hospital and nursing home stays led discussion Friday at a legislative forum on senior issues.

U.S. Rep. Joe Courtney, D-2nd District, told members of the General Assembly’s Aging Committee that he is still hearing complaints from residents of Connecticut and across the country about serious hospital stays being classified as “observation” rather than “inpatient.”

The difference is crucial, Courtney said, because Medicare covers far less of the expenses for an observation stay.

Additionally, an observation stay doesn’t meet the three-day inpatient stay requirement that triggers follow-up Medicare coverage if the patient needs a nursing home.

“It really is a problem that is sort of widening across the state,” Courtney said.

The congressman is a sponsor of a House bill that would treat observation stays the same as inpatient says for Medicare coverage of skilled nursing care. It also would relax restrictions on nursing home stays after hospitalization.

Significant problem

Judith Stein, executive director of the Center for Medicare Advocacy, said the observation-versus-inpatient issue is a significant problem. Under current regulations, hospitals have incentives to err on the side of classifying patients for observation stays rather than inpatient to avoid financial penalties.

She said two of the most common conditions that get classified as observation stays are chest pain and difficulty breathing.

U.S. Sen. Richard Blumenthal spoke during the forum about his introduced bill that aims to prevent situations of elder abuse, including manipulation by relatives to get at someone’s financial assets.


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