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Ham radio: An ‘old’ technology is a lifesaver in the emergency field

Ham radio operators working at the race command center at the 2013 Publix Atlanta Marathon

Ham radio operators working at the race center at the 2013 Publix Georgia Marathon

Like a black-and-white movie, ham radio may evoke an image of how people communicated in the old days. In fact, Hollywood legend Mickey Rooney, who died this month at 93, starred in a classic film as a teenager in which ham radio was a key plot device.

But ask someone in emergency management about ham radio, and you’ll find that this medium of communication is anything but outdated. In recent years, recognition of its importance has actually increased.

A case in point occurred in March 2008, when thousands of people were attending the Southeastern Conference basketball tournament in downtown Atlanta, and thousands more were at various venues nearby as a  tornado struck, cutting a path of destruction through the heart of Georgia’s capital city.

Unbeknownst to many, a lone amateur radio operator, using only a hand-held radio, called “CQ, CQ” — the ham radio code that signified he was reaching out to whatever stations could hear him. He hoped to alert any station on the air that he was located in the worst of the storm-affected area and needed help.

Barry Kanne, an active ham radio operator, and an Amateur Radio Emergency Service (ARES) volunteer, happened to be listening to the main ham radio weather channel as the storm hit. He responded to the CQ call. Immediately, an ad hoc emergency net between the two operators was established. Soon other stations joined in to report storm damage.

For the balance of that evening, and into the early morning hours, reports were relayed to the National Weather Service office in Peachtree City and local public safety agencies in the affected area.

Amateur radio operators have provided communications during disasters for decades, including the 9/11 terrorist attacks in 2001 and Hurricane Katrina in 2005.

They rely on their equipment and antennas to communicate using radio technologies and battery power. Amateur radio operators ensure ongoing emergency communications when Internet services fail and cellphones are rendered useless. According to a Wired Magazine blog, there are over 700,000 licensed ham operators in the U.S. today. That’s 60 percent more than 30 years ago.

They use terminology and slang unique to ham radio — an avocation for many participants. With the knowledge of this technical language comes the ability to relate on all levels, transcending barriers of native tongues and cultures, and vital to saving lives.

“Our communities rely on ham radio in a way the average citizen just does not realize,” says Steve Garrison, president of the Alford Memorial Radio Club in Stone Mountain.

“Most people are caught up in what we consider advanced technology like smartphones and the Internet,” says Garrison. “We forget how reliant they are on supporting infrastructure.”

 

A standby in times of crisis

 

Shortly after the Gulf Coast experienced the disaster of Hurricane Katrina, which left some hospitals barely functioning and cut off from outside help, the federal government recognized the important contributions made by amateur radio. The feds released funds to establish emergency ham radio stations in many hospitals throughout the country.

Post-Katrina flooding in Louisiana

Post-Katrina flooding in Louisiana

In 2007, the Georgia Department of Public Health contracted with the Georgia Hospital Association (GHA) to manage the installation of ham radios in 15 Regional Coordinating Hospitals throughout Georgia.

“A Health Resources and Services Administration grant enabled hospitals to secure redundant communication, making certain it was in place during emergencies,” says the director of emergency preparedness for GHA, Adrianne Feinberg.

By 2009, the Joint Commission, an independent hospital accreditation agency, began to focus on hospital emergency management, resulting in a dedicated emergency
management chapter as part of a standard operating procedure, says Feinberg. “Ensuring reliable communication capability continues to be a vital component of emergency preparedness,” she says.

Joint Commission standards now specify that hospitals prepare for how they communicate during emergencies as part of their internal crisis communication planning. Amateur radio is viewed as an example of backup communications that meets this requirement.

 

Hospital employees join in

 

Today, those original 15 hospital and dozens more Georgia hospitals have installed ham radio equipment. In addition, some hospital employees have obtained their own FCC amateur radio licenses, enabling them to establish vital communications while waiting for the ARES volunteer operators to arrive.

Federal Communications Commission regulations prevent amateur radio operators from receiving any compensation for performing their communications tasks. But a recent FCC ruling relaxed these restrictions for hospital employees with ham licenses, allowing them to use amateur radio equipment for drills and exercises while still on the hospital clock. This ruling recognizes the critical nature of ham radio as an emergency communication backup for hospitals.

“We strive to develop good working relationships with the agencies we serve,” says George Olive, ARES Emergency Coordinator for DeKalb County.

“By participating in drills and exercises alongside professional emergency responders, we are an integral part of events like parades and marathons,” Olive says. This Involvement keeps message handling skills sharp and helps integrate operators into the emergency management structure of their communities.

hammers

Photo courtesy of the American Radio Relay League

“What works is we get to know the emergency response team before there is an actual emergency,” Olive says.

Kanne adds, “Ham operators need to remain ready and flexible at all times. Our ability to respond in a crisis relies on having our own plan that aligns with the hospital’s preparedness needs.”

“Not only are we there when hospitals need us,” says Kanne. “But the true beauty of what we do allows doctors, employees and other hospital staff to do what they do best — provide vital patient care in an emergency.”

The task at hand is to get the messages delivered in support of the hospital’s needs. “We are their communicators,” Kanne says, “when all else fails.”

Kara Tarantino is a strategic marketing consultant in health care communications, planning and content marketing. She lives in the Atlanta area.

A health care Q&A with Gov. Deal

Gov. Nathan Deal visits WellStar Cobb Hospital in Austell last year. Photo courtesy of Andrea Briscoe

Gov. Nathan Deal visits WellStar Cobb Hospital last year. Photo courtesy of Andrea Briscoe

Nathan Deal has been involved in many high-profile decisions on health care while serving as Georgia’s governor.

Deal, who is running for re-election this year, has staked out his opposition to the Affordable Care Act (often called Obamacare) and to expanding the state’s Medicaid program. He has also supported changes to the health plan covering state employees and educators, following a wave of criticism that occurred after a new benefits framework debuted Jan. 1.

Georgia Health News recently emailed questions to Deal on a wide range of  major health care issues in the state. We received his reply Monday,  shortly before the scheduled close of the 2014 General Assembly.

In his answers, he discusses pending legislation, the federal law on ER care, the financial struggles of rural hospitals, and what he sees as ways the state can improve its health care system.

Here are GHN’s questions and Gov. Deal’s responses:

 

Q: What is your biggest accomplishment as governor in the field of health care?

A: When Washington tried to levy the huge taxpayer burden that is the Affordable Care Act on Georgians, I could not allow for billions of dollars of our state budget to be diverted from our schools and our citizens. By mitigating that disastrous impact on our state — an additional 620,000 people on Medicaid rolls and billions of dollars — we are keeping our budget balanced and protecting the people of Georgia.

Q:  As governor, you have blocked Medicaid expansion in Georgia. House Bill 990 would require legislative approval for any such expansion in the state. Do you support this legislation?

A: Yes, just the expansion of Medicaid would cost Georgia an additional $2.5 billion over 10 years. This will have major budgetary impacts so it only makes sense to have our state legislature play a part in the decision making process.

Q:  Do you foresee any circumstances under which you would support an expansion of Medicaid?

Gov. Nathan Deal

Gov. Nathan Deal

A: No, not under current conditions. I am doing everything in my power to rebuild our school funding as we come out of the Great Recession. We simply cannot afford the $2.5 billion in new spending that the expansion would require without a severe impact on public education. The federal administration needs to start acknowledging the Supreme Court ruling and look at other alternatives that don’t force new spending by the state. I have often discussed the advantages of a block grant. States need more flexibility in order to make their program work for their unique population rather than a one-size-fits-all Washington mandate. When I was a congressman, I served as chairman of the health subcommittee of Energy and Commerce. The need for flexibility is not new to me, but serving in my role as governor has only reinforced the notion that states can operate more efficiently with flexibility.
Q: HB 707 would prohibit employees of any state unit from spending state funds to advocate for Medicaid expansion. It would also bar the University of Georgia from operating its current navigator program, which hires and trains people to help consumers use the health care exchange. Do you support this legislation?

A: It is my policy to not comment on pending legislation that is not part of my legislative agenda.

Q: You recently commented that changes to the federal EMTALA law (requiring hospitals to treat arriving ER patients) can help reduce health care costs. Can you expand on those comments?

A: I have always been a supporter of promoting primary care and preventative care as opposed to emergency room visits for non-emergency circumstances. In the case of a true medical emergency, people should always have access to emergency rooms. However, for non-emergency situations, we should encourage those people to seek treatment in a more cost-effective setting, thus opening beds and reserving resources for those in most critical need. Because there is some confusion on this issue, let me be clear: No one’s going to be denied service. None. This isn’t about blocking doors to health services. It’s about opening new doors that yield better health outcomes at a fraction of the price of emergency rooms. The onus is on us to make sure these non-emergency resources are available and convenient to the populations in need of service.
Q: Four rural hospitals have closed in Georgia over the past two years. Can the state of Georgia do anything to prevent more from closing?

A: I recognize the critical need for hospital infrastructure in rural Georgia, as they save lives and maintain our communities. Hospitals large and small have all felt the impact of the recent economic downturn. While support that these hospitals received has diminished, I am hopeful that as the economy improves, so does the flow of funding and contributions that keep our rural areas thriving. We will continue to monitor the situation with the Department of Community Health.

Q: The changes to the State Health Benefit Plan that began in January have sparked a wave of criticism from educators, state employees and retirees. Will the pending switch to a co-pay system alleviate the members’ concerns?

A: The intention of those changes was to lower out-of-pocket health care costs for state employees. The SHBP already covered 100 percent of preventative care visits, and these improvements give employees an additional layer of security so they can do the right things to stay healthy. I believe the changes address the core concerns of our employees, but the Department of Community Health will continue to monitor and evaluate the situation.

Q: Medical marijuana has suddenly become a high-profile topic in the General Assembly. Do you support this legislation that would create a mechanism to help children with seizure disorders?

A: As I said previously, it is my policy to not comment on pending legislation that is not part of my legislative agenda.

Q: What can be done to improve the health care system in Georgia?

A:  Since taking office, I have focused on the need for additional health professionals in Georgia. We have been increasing the number of residency slots in hospitals across the state. Georgia taxpayers help fund a promising young Georgian’s pre-K, K-12, post-secondary and graduate-level medical education only to see them perform their residency outside of our state and not return. That doesn’t provide value for Georgians paying taxes. It doesn’t make sense for Georgians needing care and it isn’t fair to young Georgians looking to begin medical careers. We must ensure that no doctor trained in Georgia is forced to leave the state to complete his or her medical education. There is still work to be done, but we are making strides on this front. Individuals in Georgia can also play a major role in improving their own health by being active in their healthcare decisions. This means taking advantage of all the preventative care opportunities to improve the well-being of themselves and their families.

 

 

 

 

Sharing medical stories: The blossoming of hospital social media

Emmy Lott at Children's Healthcare of Atlanta

Emmy Lott at Children’s Healthcare of Atlanta

When Atlanta-area couple Emory and Courtney Lott adopted their daughter Emmy, she was just 3 weeks old, but they were already anticipating frequent visits to the doctor’s office.

Emmy was born with sickle cell disease. Now 4 years old, she suffers from debilitating symptoms such as limb pain, high fevers and spleen problems. She has been admitted to the hospital more than 50 times.

Sickle cell deforms red blood cells and causes them to clog small blood vessels. This creates a process of inflammation and oxygen starvation, resulting in intense pain. The disease evolved as a mutation to protect people against malaria, and sub-Saharan Africa is one of the major areas where that took place. That is why the sickle cell trait, which occurs in various ethnic groups, is especially common among African-Americans.

Last March, Emmy developed a severe case of acute chest syndrome, a potentially fatal lung-related complication that occurs in some sickle cell patients. Emmy’s treatment and recovery required an extended stay in the Pediatric Intensive Care Unit at Children’s Healthcare of Atlanta at Scottish Rite Hospital. It was during this particular admission that her mother decided to share Emmy’s story via social media.

“She was very, very sick, so our doctor suggested that I make a Facebook page as a way to take my mind off of how sick my child was,” Courtney Lott said. “The page was a way to update people, have people praying, and let them know what was going on.”

Lott created a Facebook page, “Pray for Emmy,” which has grown into a group with more than 3,800 followers. Lott posts on the page fairly often, as followers inquire about Emmy’s condition and express interest in how she is doing overall.

EmmyLottCHOA“Emmy is like a little celebrity,” Lott said. “I’d say that 99.9 percent of the time, we have had an overwhelmingly positive response on social media.”

Just a decade ago, social media groups like Emmy’s did not even exist. In fact, most social media platforms were just starting out and were rarely, if ever, exclusively used for health care communications.

Now, hospitals all over the state and the nation are using social media.

According to the Georgia Hospital Association, 77 member hospitals currently have Facebook pages and 41 have Twitter accounts.​

“In many hospitals throughout Georgia, social media has become an integral part of the way that these organizations communicate with patients, families and employees,” said Erin Stewart, the GHA’s director of communications and social media. Use of social media “has helped strengthen hospital-patient relationships and has allowed hospitals to be part of the conversation that members of their community were already having about them.”

Tracy Dean, manager of social media content at Children’s Healthcare of Atlanta, has watched the rise of social media and the key role it plays in CHOA’s engagement with the patient community.

“From the grocery store to baseball fields, the care we provide is a topic of conversations between moms and dads, grandparents and neighbors,” she said. “Today many of the conversations have moved online with social media. These open platforms amplify messages and allows for us to publicly engage with these individuals and groups of people.”

 

Knowing the risks

Of course, people’s social media posts can potentially reveal a lot of personal information, sometimes including sensitive medical data. And so, as more health care facilities turn to social media, questions have emerged about privacy. The Emergency Care Research Institute released new guidance on social media practices in early 2012.

In a January 2012 press release, Paul Anderson of ECRI addressed the importance of establishing social media policies and procedures to counteract privacy concerns and other potential risks.

Emmy and Courtney Lott

Emmy and Courtney Lott

“I won’t tell you that you have to join Facebook or set up a Twitter account, but your patients and staff are using these tools,” Anderson said. “Yes, there are privacy and reputational risks, but social media can present tremendous opportunities for hospitals to communicate with their communities, patients and staff.”

At CHOA, Dean said, her team first addressed HIPAA privacy concerns when it sought to align hospital-wide social media with employee policies on e-communications. This led to the establishment of CHOA’s social media policy.

“According to our social media policy, by posting any content to our social media sites, the user grants Children’s the right to reproduce, distribute, publish or display content on our channels,” Dean said. “In addition, CHOA’s Marketing and Communications obtains digital consent forms for all patients we photograph and film — this safeguards us to have this content appear on our social channels.”

When Courtney Lott posts photos and status updates to social media with the #CHOA hashtag, the hospital’s social media policy is in the forefront of her mind.

“I always try to be very cautious about what I am posting and make sure it doesn’t go against any of their policies,” she said. “I am also friends with a lot of the nurses, so I check with them before posting. They are supportive of that.”

The sharing that’s possible through social media has helped to form patient relationships and online communities for families like the Lotts. CHOA’s official social media have shared Lott’s Facebook posts about Emmy in an effort to support her and raise awareness of sickle cell disease. A special digital relationship has developed between the hospital and the families it serves.

“We saw this as an opportunity to provide engaging content through our digital channels that would help people open up and connect about their experience,” Dean said.

EmmyPortraitFor Lott, social media engagement has led to friendships with fellow families of sickle cell patients at CHOA, and support from friends and complete strangers.

“Using social media as a white mom with a black child, it can be very hard for me to connect with others,” she said. “So I’ve used social media to find a community and to have people who know what I am going through.”

Today, Emmy continues to have occasional high fevers and blood transfusions. Her severe symptoms sometimes result in precautionary emergency room visits. When that happens, Lott spreads the word through social media.

“We are at CHOA much as we are at home.” Lott said. “They are truly our second family and I am thankful for that. We just sing their praises.”

 

Natalie Duggan, a GHN intern, is a senior at Emory University, majoring in journalism and anthropology, specializing in health writing. She has previously interned at the CDC, the CNN Medical Unit, and was a summer 2013 ORISE research fellow at the National Institute of Allergy & Infectious Diseases.

Hospitalists: The specialists whose patients all have beds

Nurse practitioner George Mackel (right) is one of the first hospitalists at Morgan Memorial Hospital

Nurse practitioner George Mackel (right) is a member of the hospitalist team at Morgan Memorial.

Morgan Memorial Hospital in Madison got tired of having so many patients who were just passing through.

Too often in the past, the hospital has stabilized newly arrived patients, only to see them quickly bundled off to Athens for further treatment.

Ralph Castillo, the administrator for the 25-bed hospital in one of the most famously beautiful communities in Georgia, thinks he has the solution to this stopover problem.  He has launched a program that he says will save lives and keep more patients in Morgan County, closer to home and family.

Castillo introduced a team of hospitalists – mainly physicians who specialize in the care of patients who are admitted to a hospital.

Morgan Memorial has brought in a hospitalist group of nine physicians and five nurse practitioners/physician assistants who manage and coordinate all aspects of a hospitalized patients stay while working closely with a patient’s primary care physician– from admission until discharge.

The idea, Castillo says, is to increase patient and physician satisfaction. Every day, a hospitalist comes in very early, catches up with the nursing staff on any overnight developments, and tends to about 10 patients in an eight-hour shift.  That’s about 60 percent of Morgan Memorial’s inpatients on an average day.

Previously, all six of Madison’s primary care doctors came to the hospital to see patients who had been admitted.  Castillo said having hospitalists at Morgan Memorial enables doctors in the community to see more patients in their offices, while inpatients have a hospital-based doctor to respond quickly and expedite their recovery.

A new idea for a small town

Most people around Madison don’t even know what a hospitalist is.  But that’s probably true of most people around the country.

“Hospitalist” is a relatively new medical specialty, one rooted in a California experiment that began in 1992.  The term “hospitalist” was coined four years later in a New England Journal of Medicine study.

Morgan Memorial Hospital

Morgan Memorial Hospital

Studies conducted in Minneapolis, Long Island, N.Y., Los Angeles and other urban areas indicate that hospitalist programs can decrease the average length of hospital stays by up to 35 percent.  In Georgia, hospitalists have been around for a while in larger, regional hospitals.

But almost no data are available anywhere about hospitalist programs in small or rural facilities.

Because the service in Madison is only a few months old, its impact on patient care remains unclear.  And there are skeptics.  Not every local doctor has agreed to cooperate, and pharmacists are worried that working with hospitalists could make their job harder.

Morgan Memorial does not directly pay the salaries of hospitalists.  They are part of an Integrated Care Program (ICP), a bundle of inpatient and emergency department services that cost the hospital $800,000 to $900,000 annually.

Since the hospitalists went to work at Morgan Memorial about four months ago, the average number of  inpatients is higher by one to two per day.

“There were more patients leaving our ER room than they needed to,” Castillo said, “and having a hospitalist here enabled us to keep more patients here for the routine medicine rather than automatically shipping them to Athens.’’

Castillo said the hospitalist program also makes life better for primary care doctors in the community, giving them more free time.  “I’ve got one physician in particular – he’s been able to travel outside the state of Georgia more often than he had in the past,” Castillo said, “and he’s also been able to actively participate in both of his children’s extracurricular activity.”

Benefits vs. drawbacks

Four of Madison’s six primary care doctors have agreed to hand off acute care patients to the new specialists at Morgan Memorial.

One is Dr. Dan Zant, a family practice physician who’s also chief of staff at the hospital.

“It helps me be free to tend to my patients in the office,’’ Zant says. “It’s helped me expand my hours to see more patients.’’ And after hours, he says, the hospitalist program allows him “to turn it off and enjoy some family time.’’

Dr. Miguel Cossio – known as “Dr. Mickey” to his patients – is one of two who have not.  He says he feels strongly obligated to continue seeing his patients when they are hospitalized.

“It’s like you have a friend,” he said of the patient-doctor relationship.  “When times are good, everyone’s your friend…but a true friend is there in the good times and the bad.”

Though Cossio says he has “no opinion one way or the other” about the hospitalist program, he made clear that has no intention of switching over to it.

Local pharmacist Elise Lang, who practices at Thrifty Mac, worries that the hospitalist program will make it harder for pharmacists to stay in the patient care loop.

The Affordable Care Act, she said, has already increased paperwork for folks in her profession, especially when ventilators or other medical equipment are needed.  In such situations, pharmacists need more information from the treating physician.

But hospitalists, who see only inpatients, don’t necessarily have every patient’s complete medical records on hand when the pharmacist calls, Lang said.

And sometimes these physicians are harder to reach than office-based doctors.  “They don’t keep regular business hours,” Lang said.

Other area pharmacists say they’ve faced the same issue when trying to fill orders for patients hospitalized at larger facilities with hospitalist practices, including Athens Regional Medical Center.

The full costs and benefits of Morgan Memorial’s hospitalist program remain to be seen.  Most hospitals don’t see the positive effects until at least a year of services, experts say.

“At the end of the day,” said Castillo, “we want the patient well and on their way, just like the primary care physician wants the patient well and on their way.”

 

Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets.

 

Patient classification — a complex subject, but too important to ignore

corridor in hospital / Flur im Krankenhaus

The wife of a retired Atlanta physician recently got a stunning lesson when her husband spent some time in a hospital.

“We realized there might be a problem when he was not served breakfast along with the other patients,” she said.

That was when they were told he had not actually been admitted to the hospital.

“But he’s in a hospital bed, and he’s here in the hospital,” responded the wife.

“Yes,” a nurse explained. “It can be confusing.”

The wife, who is requesting anonymity due to privacy concerns, got another shock when the hospital bill arrived. During her husband’s hospital stay, he had received the same routine medications he took at home, but the amount the couple was being charged for those drugs far exceeded what they paid at their pharmacy.

The lesson the couple learned is that being “hospitalized” can mean different things.

Many Medicare patients are placed under “observation status’’ when they arrive at a hospital. That means they are considered outpatients and are not formally admitted, even if they are given a bed.

For a patient under observation status, Medicare reimburses the hospital differently. And that may increase the out-of-pocket costs that Medicare patients face. (But if the patient has a Medicare Advantage Plan, such as an HMO, cost and coverage may vary.)

Hospitals may get an indirect financial benefit when they place people on observation status.

For instance, a patient who is formally admitted to a hospital counts as a readmission if he or she has recently been discharged from that facility. An outpatient does not count as a readmission even if he or she has been discharged recently. This is important because readmission statistics affect a hospital’s bottom line. If the facility records a high number of Medicare patients being readmitted within 30 days of a discharge, it faces federal penalties on its reimbursements.

As hospitals try to avoid the costly problem of too many readmissions, the patient may be caught in the middle.

 

The vanishing inpatient

 

Keith Lind, senior policy adviser for AARP Public Policy Institute, said recently that a national study found that both one-day inpatient stays and inpatient stays of all lengths declined by about 16 percent during the study period. But at the same time, the report said, “the ratio of observation use to inpatient stays per 1,000 beneficiaries increased by 94 percent.”

Hospital Outpatient Entrance SignSometimes financial complications arise for patients, as when a Medicare patient is transitioned from being “observed” in the hospital to being treated in a skilled nursing facility, such as a nursing home or a rehabilitation unit.

The patient must first have been an inpatient for at least three full days for Medicare to pay toward the skilled nursing facility stay.

To help Medicare beneficiaries, CMS urges patients to question every hospital stay and find out if they are listed as inpatients or outpatients. But often a patient may be too ill to ask Medicare-related questions, and the family will sadly discover the difference when the skilled-care bill arrives.

Dr. Cheryl McGowan, a Georgia family medicine physician, recalls the situation at a hospital where she trained. Sometimes residents would admit a Medicare patient from the emergency room to an inpatient unit, but then learn that the patient did not meet the hospital’s criteria for inpatient admission. The physician would then be asked to change the patient’s status to observation.

A patient kept for observation may later qualify for inpatient admission, depending on the results of tests or changes in physical status during his or her stay, McGowan said. Such changes in patient designation can lead to confusion for everyone.

One CMS example illustrates some of the many variables: If a Medicare patient arrives in the emergency room with chest pain and the hospital keeps the patient two nights for observation, Medicare Part A, for inpatient hospital care, pays nothing. But Medicare Part B, for outpatient care, covers lab tests, EKGs, and certain other items, just as if the patient had been seen in a physician’s office.

Part A and Part B have been referred to as a full menu vs. à la carte. The à la carte or individually charged items can add up rather quickly under Part B. Hospitals get lower rates for room and board. But services such as X-rays, MRIs and the like are reimbursed individually, which helps the hospital.

To further complicate things, there is the two-midnight rule.

Last year, the federal Centers for Medicare and Medicaid Services issued a new policy on observation status. When a physician expects to keep the patient in the hospital for a period of time that does not cross two midnights, the services should be paid under Part B, or outpatient services.

Carol Levine, who heads the United Hospital Fund’s Families and Health Care Project, said at a recent Washington briefing that this two-midnight rule “continues to leave patients and families exposed to high and unexpected costs associated with what seems like an ordinary hospital stay.”

That’s because stays lasting less than two midnights will not be presumed to qualify as inpatient stays — and instead will be paid under Part B, which covers only outpatient services.

The co-pay for an individual service under Part B won’t be higher than Part A, but an overall total of the Part B patient co-pays might be. Costs can rise when they are individually billed, as opposed to the “package” pricing found under Part A.

 

Observation wards?

 

Today, hospitals must make patients aware of their inpatient or outpatient status. For example, if the physician writes an inpatient admission order and a hospital review changes the status to outpatient, there must be written notification of the change.

But do Medicare patients always understand the significance of a changed classification? As noted above, even some medical professionals admit it’s confusing.

smslogoPhysicians who are trying their best to deliver good care can be as frustrated as patients with the current situation. Dr. William Silver, the president of the Medical Association of Georgia (MAG), said the organization joined a number of state and national medical societies to push through a resolution urging the AMA to press for repeal of the two-midnight rule “because it only exacerbates the heavy and unreasonable administrative burden that’s been placed on physicians by the federal government and other third-party payers.”

In a joint letter to CMS in November, the American Medical Association and the American Hospital Association suggested a delay in enforcing the new two-midnight rule until Oct. 1, 2014. In the meantime, CMS has extended the delay in enforcement through March 31.

A potential solution that may protect the interest of hospitals and physicians is the establishment of hospital observation units.

On a recent PBS NewsHour program, Dr. Michael Ross, associate professor of emergency medicine at Emory University School of Medicine, and co-author of a study published in Health Affairs, said patients may require less than 24 to 48 hours of observation. The article suggests a unit just for those being observed may actually cut costs for the patient and the hospital, depending on the individual’s diagnosis and treatment.

But a further concern was brought up by Susan Reinhard, senior vice president at AARP: How will a hospital cover the cost of increased observation nurses if nurse-patient staffing is based on inpatient beds?

Reinhard says about a third of the hospitals in America already have dedicated observation units.

Ross and Reinhard, based on their research, say the majority of hospitals send patients to empty beds somewhere in the facility, a situation that offers less than the optimal setting for observation. They both wonder whether some of these patients are observed for far too long and should be formally admitted earlier.

 

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

 

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