Case Management Advocacy On The Hill Day

On April 19, I was given the honor of participating in Advocacy On The Hill day with members of the American Case Management Association. This day of advocacy was arranged for members of the ACMA attending the annual conference in D.C. The agenda of the day for the group was talking with legislative staff about the Improving Access to Medicare Coverage Act of 2017.

The Senate Bill, 568 was introduced by Sherrod Brown, Democrat, from Ohio and House of Representative Bill, 237 introduced by Don Young, Republican, of Arkansas. This was not the first time this piece of legislation was presented for review by the Senate and House of Representatives and without gaining support it will not be the last.

Raising awareness and support for this bill was the reason for Advocacy On The Hill day. After being transported as a group to the Capital, the attendees were given a brief overview of the legislative process and then detailed information on the Improving Access to Medicare Coverage Act of 2017. The area of great interest within this bill for the group involved the portion addressing the Observation Status specifically how it impacts Medicare Beneficiaries.

Observation Status is a hospital admission classification that allows a patient to be in a facility, receiving care but designated as an Outpatient. The care provided is based on patient/family consent, physician orders, medical condition and standards of care. Admission status does not determine care. Observation patients can be found throughout the hospital with some facilities having a designated unit.

While the care a patient receives is not impacted by the admission status, it does have financial implications for the patient. Patients hospitalized under the Observation Status have their bill paid at 80% and are responsible for the remaining 20% if they do not have secondary insurance coverage. This can be difficult to manage but is not the only potential disaster lurking in the wings for patients. Patients hospitalized as Observation Status do not accrue 3 consecutive inpatient midnights regardless if they are in the hospital for the same time span. Patients who do not meet this specification do not qualify for skilled nursing facility payment.

Patients who have not met this requirement are often left with difficult post- acute care decisions if they need continued inpatient care in a skilled nursing facility. Few are able to pay privately for the services and return home to what could very well be an unsafe situation. These patients are at risk of being readmitted to the acute care hospital setting because of limited family support, inadequate community resources and their own vulnerable conditions.

The Improving Access to Medicare Coverage Act of 2017 seeks to qualify the hours a patient is hospitalized to count towards the 3 continuous midnight’s requirement for Medicare payment in a skilled nursing center, regardless of admission status. This will allow the patients to receive inpatient rehabilitation services to obtain the maximum level of health and function before returning to a home environment.

This bill does have strong bipartisan support. The legislative staff members that were representing various congressional members indicated they had knowledge of the bill and were supportive. The cost of implementing this bill has yet to be documented by the Congressional Budget Office and this is the only identified barrier to the bill becoming law.

As Case Managers we have been trying to make the Observation Status work for our patients. Case Managers have become creative, resourceful and passionate advocates in our attempts to make the impossible come possible for our patients. We have been successful at times but spend sleepless nights thinking about the patients who have not experienced the same success. It is for these patients, you are encouraged to contact your congressional representatives.

Share the stories! Tell the tales! Reveal the reality! Our patients are counting on us.

Cathy M.