Hospital officials and a Medicare advocate expressed their extreme frustration with Medicare's two-midnight and observation rules before the House Ways and Means Subcommittee on Health hearing Tuesday, saying that not only are the policies not working, they've also added huge costs and quality issues for providers and patients.
"We know the two-midnight rule was spawned out of an attempt to limit lengthy stays and add clarity to the definition of an inpatient," said Amy Deutschendorf, senior director of clinical resource management at Johns Hopkins Hospital in Baltimore. "Unfortunately, the rule adds a new layer of complexity that not only does not meet the [Centers for Medicare & Medicaid Services] objective, but has created confusion and stress for our providers and patients, and has been operationally difficult to implement."
Meanwhile, patients are being assigned to observation status to avoid visits from Recovery Audit Contractors, Deutschendorf and others said. Those RACs are questioning far too many claims as inappropriate, a number that "has increased by 33%" in the last year and has "required our physicians to become soothsayers as they try to project" whether an emergency room patient with multiple symptoms and comorbidities will require a stay that lasts longer than two midnights, she said.