A Public Service Announcement

Most times, I try to stay out of the business of explaining to laymen the nuances of health care billing issues. Probably because it always ends up with me trying to defend stupid insurance rules, which is not a point of strength for me.

But this one really has my hair up. And the public should understand this nuance. So here you go, public:

"We're going to admit __________."

Fill in the blank with you, your wife, your husband, your mom, dad, grandma, son, daughter...etc.

Upon hearing these words from a doctor, most are overjoyed that FINALLY someone is listening and they've decided to put ________ in the hospital!

We are going to get answers! He/She is not just making it up! Ugh.

Cell phones blaze in a moment of glory.

But let's pause the video here for a moment, Bob, because there is some vital information missing:

Let's review:

"We're going to admit ________ to observation."
"We're going to admit ________ to inpatient."

See those two words at the end? Those two words mean everything when the bill gets calculated and the amount owed by the patient is tallied.

Because of the fairly recent CMS (Centers for Medicare and Medicaid Services) two midnight rule, when evaluating a patient, doctors must determine whether or not he or she thinks the patient will require less than a two day stay or at least a two day stay.

If less than two day, the patient is placed in observation. If more, the patient is placed in inpatient. (And don't get me started on Condition Code 44. That is yet another post.)

Observation means outpatient status. Yes, you or your loved one is in the hospital, but did you know that you can be considered an outpatient yet still be in the hospital? Maybe not.

Inpatient means really, truly, and most assuredly in the hospital and likely to visit many a step-down unit like cardiology, pulminology, ICU, etc.

This all matters because of how insurance will pay.

Insurance plans pay based on whether or not the service is provided under outpatient rules or inpatient rules.

While I am reluctant to provide a dissertation on every insurance carrier known to man and Obama Care, please know that those two simple words make a difference.

It's important to ask your admitting physician whether ________ is being admitted to observation or inpatient status and to also ask WHY.

Although, I am quite sure that after 1mg of Dilaudid the patient won't care, and neither will the family because the bitching has finally stopped, but anyway. ASK.

Then you attain a position of knowledge and hopefully won't have a heart attack upon receiving the bill which will then put you in the hospital under either outpatient observation or inpatient status.

This has been a Public Service Announcement. Thank you for your time.

My dad was right:

Stupid should hurt.

Now I know there is a smart-ass gene

Driving home from errands today with Chris in the car. He had valiantly volunteered to accompany me to to the store. Of course, this trip was somehow coupled with a quick (extorted) detour to Game Stop, but still.

I will take the company of my teenage son even if I have to pay for it.

Cruising up the road to the house, I started griping about the road and how the dump trucks going back and forth for construction have completely ruined it. There were potholes everywhere.

What follows is as true a transcription as I can conjure after a much needed beer:

Me: <griping about the potholes>

Chris: They don't bother me really.

Me: Well, they don't bother me either. I mean like, as a person. It's the car I'm worried about!

Chris: What's wrong with the car?

Me: Well, nothing yet. But the alignment is going to hell.

Chris: What's an alignment?

Me: <thinking> Okay, well take a bike, for instance....

Chris: You mean, like steal? Because that is wrong. Are you suggesting I steal a bike for your example?

Me: Well, no, I meant....

Chris: Well, good. Because if you are encouraging me to steal, I'd have to report you.

Me: Okay, crap. Well, IMAGINE you have a bike...

Chris: Is this the same bike I just stole? Or did I buy it? And what color is it?

Me: Uh, you bought it and it's green. Kind of like the one you always wanted as a child but I never bought you.

Chris: Well, I don't like green. I'm glad you never bought it. Can my imaginary bike be blue?

Me: Anyway, so the bike has handlebars that steer the bike wheel, right. And when the handlebars go kittywampus you can't steer. So it's like a car. The two wheels in the front steer the car and the steering wheel controls that.

Chris: So our car has three wheels? Or five, really? And who the hell says ‘kittywampus’ anymore?

Me: Sigh.

Chris: No, please. Go on. This is interesting.

Me: Well, car hits pothole, alignment goes to hell, you fight the steering, can't brake properly, tires wear faster, and gas mileage goes to hell.

Chris: So, how is that like the bike?

Me: Forget the bike.

Chris: But I just bought it!

Me: Forget the bike. You don't need it.

Chris: Good, because I have you to drive me everywhere.

Me: .....

I saw this car outside of the ABC store today. As a testament to my outstanding character, the following immediately came to mind: 

1. You're drunk.

2. You fumble with getting the keys in the lock and drop the keys.

3. You bend (fall) over and mash your face along the car door on the way down.

4. The door opens.

If providers are under the gun from having patient satisfaction tied to reimbursement then shouldn't Medicare/Medicaid recipients have continued coverage tied to provider satisfaction?

Non-compliant? No soup for you!

Didn't lose the weight? No soup for you!

Still smoking? No soup for you!

Fourth kid on Medicaid? No soup for you!

Seriously.

Why do the "powers that be" punish providers for supposed substandard performance but are unwilling to put performance standards on patients? Especially the ones on the taxpayer dime?

Patients need performance standards, too.