Observation status - in which hospitalized Medicare beneficiaries are classified as outpatients for billing status - has long been a concern of hospitalists. 

An article in Today's Hospitalist quoted Ann Sheehy, MD, MS, associate professor and head, Hospital Medicine, about her work to lead the national drive to overhaul observation care.

"There’s an entire industry of staff now working in hospitals solely to maintain this two-tiered billing status," said Dr. Sheehy. "But none of it actually improves patient care. It’s only to figure out the right bucket to bill Medicare or private payers." 

Despite continued frustration among clinicians and patients about observation policies, momentum for further reform has stalled because Congress passed an act in 2015 that required hospitals to notify all observation patients about their outpatient status. 

“When Congress passed that act, they felt they’d done something in the observation space, even if it didn’t fix the core problems,” said Dr. Sheehy.

Hospitalists quoted in the article offered a wish list of several ways that observation care delivery could be improved, but next steps in policy changes remain unclear.

Resources:

• "Observation care: Is it still stressing you out?," Today's Hospitalist, January 2018

Photo credit: Clint Thayer/Department of Medicine