Guest column: Latham steps up for Iowa’s seniors

The Des Moines Register’s April 19 editorial, “Can’t Have it Both Ways on Medicare,” brought to light a complex and confusing process that affects many Iowa seniors – observation stays in hospitals.

When an elderly patient on Medicare is admitted to a hospital for a medical emergency, the patient’s admission must be classified as “inpatient” and meet a minimum three-day stay requirement in order to qualify for Medicare skilled nursing facility rehabilitation and therapy benefits when discharged.

Unfortunately, it has become increasingly common for a patient to remain in the hospital for more than three days for “observation,” while receiving the same level of care as if admitted as “inpatient.” The result is, the person must either forego needed rehabilitation care or pay out-of-pocket for benefits at a skilled nursing facility that as an inpatient they would have qualified for through Medicare.

Many of these vulnerable Iowans and their families have no idea that the key to their recovery – rehabilitation and therapy – will not be covered by Medicare because the physician did not have them admitted to the hospital as inpatient.

There is no clear medical distinction between an inpatient stay and an observation stay, especially if the patient is elderly and frail. Nationwide, we are seeing patients kept in the hospital longer for observation stays. In fact, from 2007-2009 the number of patients spending four or more days under observation status has nearly doubled.

This simple classification difference may drastically affect the care a person receives once discharged from a hospital, possibly hindering their recovery or contributing to a possible re-hospitalization. Oftentimes, rehabilitation and therapy received during a short stay in a nursing facility following a hospital stay are crucial to ensuring the patient is strong enough to return home safely.

Congressman Tom Latham is determined to ensure that Iowa’s Medicare-eligible seniors qualify for the benefits that cover the care they need after being discharged from the hospital. Latham has invested in good public policy by introducing the Improving Access to Medicare Coverage Act of 2011.

The legislation ensures that time spent in a hospital under observation status will count toward the three-day inpatient hospital requirement to receive benefits for skilled nursing and rehabilitative care services under Medicare. As the Register states, this legislation is endorsed by a majority of groups, and for good reason – a benefit promised by Medicare for the elderly and frail is being withheld due to an administrative decision by providers.

We applaud Congressman Latham for stepping beyond the Washington rhetoric to ensure that seniors in Iowa and nationwide are allowed to qualify for the Medicare benefits available to them following a hospital stay. The current process of using observation stays is creating extensive and increasing hardships for patients and their families during an already difficult time.

Public policy must focus on the best interest of the patient – not the health care system. By introducing this legislation Congressman Latham has shown that his first concern is the well-being of Iowa’s seniors.