Observation Status Rules Rankle Hospitals, Patients

Cheryl Clark, for HealthLeaders Media , December 13, 2010
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That situation exacerbates overcrowding in the emergency room when admitted patients must be boarded until a room is available, she says.

Toby Edelman, senior policy attorney with the Center for Medicare Advocacy in Washington, DC, says she knows the observation problem is expanding because she gets at least one complaint a day from weeping family members over bills they never thought they'd have to pay.

She adds that, at long last, there's one issue on which hospital officials, advocates, and skilled nursing homes agree with family members and patients. There has to be a way to put a limit on the number of days a patient can stay in the hospital, after which the patient must be admitted, so follow-up care won't break the family bank and hospitals can be paid for the quality care they deliver, she says.

From Sandi Lubrant's perspective, the situation seems to be a growing nightmare. The last time her mother was taken to the hospital in September, "she had fallen after dinner while throwing bread crumbs to the birds and hit her head on the doorjamb and then the floor, resulting in a goose-egg-size knot on her forehead and concussion."

She couldn't walk, didn't speak like she usually did, and was unable to finish sentences. Again, she didn't meet evidence-based criteria for admission, Lubrant says. Her status was classified as "observation."

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