93% of Hospitalist respondents rated observation policy as critical, but close to two-thirds were not confident in determining a patient’s status.
For several years, hospital-based practitioners have struggled with observation status, the two-midnight rule, and recovery audit mechanisms. Doubly so because of the evolving regulations CMS continues to proffer. Expect additional guidance as the workings (and vagaries) of the rule still plague patient admissions.
We all toil with “medical necessity” and what the term means. The linchpin of successfully implementing the rule hinges on deciphering that very term. We look towards colleagues, administrators, and consultants for aid.
However, after countless internal meetings, conference calls, and failed attempts in obtaining an instruction manual, we realized no one had answers. Moreover, we at SHM did not know if members were coping and applying the rule in a consistent manner.
There has been plenty of national news coverage, but given the absence of any nationwide data–from any regulatory body or professional society–we at the Public Policy Committee perceived a need to accrue information from members on how the rule affected front line clinicians. Again, no one had undertaken a survey as large and comprehensive as ours.
Months of work have led us to our white paper, entitled, The Observation Status Problem: Impact and Recommendations for Change. The release utilizes a multidimensional data set of significant size and includes a finding synthesis. It is our hope to use the information we collected to inform Congress, CMS, media, and members on the somewhat chaotic understanding of observation status policy. The answers came from you, our nation’s inpatient workforce.
To give you a sense of what we wished to query, our efforts focused on how you comprehend the rule and received training in its use, if the rule interfered with your clinical decision-making, and whether the regulation may have negative impacts on beneficiaries.
We have assembled a formidable document. I can confide the findings will raise some eyebrows, and after you read the results, I am certain you will concur.
Accolades must go to many folks within our organization for a job well done! Ann Sheehy MD, MS testified last month in Congress and repeated her role on July 30th, in the Senate Special Committee on Aging. We all anticipate improvement on the observation policy front–resulting from both the dissemination of our paper, as well as our continued advocacy efforts in Congress. Now go read!
Note: When discussing the observation status issue, use #ObsStatus and tag @SHMLive.
Bradley Flansbaum, DO, MPH, MHM works for Lenox Hill Hospital in New York City. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM and NY ACP Public Policy Committees and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a proud resident of New York City.