Seniors pay the price for Medicare’s two-midnight rule

The old adage “time is money” holds true, especially in health care. Apparently the medicine time crunch spans two midnights.

In October 2013, Medicare enacted a provision that changed coverage for hospitalized patients. The “two-midnight rule” states that a patient will not be covered as an inpatient unless their hospital stay is expected to cross two midnights. The end result is that many seniors are placed under observation, even if they stay in the hospital overnight and have serious conditions that require a hospital stay.

Consider someone who has appendicitis. After evaluation in the emergency room, they are rushed to surgery. If there are no complications with the surgery, the patient usually goes home the next day. That is an expected stay of one midnight. Think about that for a minute. This person just had emergency surgery that if left unchecked could have killed them. But this does not meet Medicare’s strict timeline criteria.

Staying more than two midnights does not mean they qualify for inpatient status either, not unless other criteria are also met. This results in major cost shifting to the patient and an increase in out of pocket expenses.

Medicare is not the only one on a schedule. The majority of hospitals nationwide do not offer the same level of service on the weekend as they do on weekdays. Patients are all too frequently left in hospital beds over the weekend waiting for Monday tests, studies and procedures. If they are under observation on Medicare, this is a double edged sword. They are paying the high cost of a bed as if it is a waiting room.

It seems Medicare beneficiaries are the ones who pay the price for time. Somehow these patients are being penalized for being sick at the wrong time or not sick enough. It isn’t fair.

Instead of shifting costs to patients, the focus should be on receiving appropriate care in a reasonable time frame. If hospitals offered the same level of services 24/7, hospital stays could be shorter for patients. This would decrease costs and open bed availability for other patients.

While this approach would of course require changes in hospital work flows and initially increase hospital operating costs, hospitals could potentially see higher dividends in the long run. Patients are unlikely to afford the high costs of long hospital stays but may be able to pay in part for shorter stays. If Medicare stepped in and revoked the two-midnight rule, this would help to relieve the burden on hospitals and patients alike.

The two-midnight rule is a direct challenge to our seniors. It makes them pay more for the same level of care. Health care should be less about cost and more about quality. Too many Americans avoid getting necessary health care until it is too late. They simply cannot afford the time.

Tanya Feke is founder, Diagnosis Life.

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