20140915-NEWS--1-NAT-CCI-CL_-- 9/12/2014 3:55 PM Page 1 $2.00/SEPTEMBER 15 - 21, 2014 Hospitals hoping time runs out on SLAM DUNK midnight rule By TIMOTHY MAGAW
[email protected] For some Medicare patients, sitting in a hos- pital bed overnight doesn’t necessarily mean they’ve been admitted. Consider it the Medicare version of purgatory, and it’s confus- ing patients and taking a chunk out of local hos- pitals’ bottom lines. Last year, the cash-strapped Medicare pro- gram instituted a rule that stated that patients needed two nights — make that two midnights — in the hospital to qualify for inpatient-hospi- tal rates. If they don’t cross that two-midnight threshold, hospitals must bill at the lower, out- patient rates. Basically, it injects a time element into a doctor’s decision of whether to admit a patient, and hospitals are clamoring for a change. “It is so convoluted now and under such fire they’ll have to do something to change it,” said Don Paulson, University Hospitals’ vice presi- CAVS’ dent of revenue cycle management. The rule, according to Moody’s Investors Ser- vice, has the potential to cost hospitals $3,000 to $4,000 per case. ‘ALL OHIO’ That’s big bucks, considering about 40% to 50% of most hospitals’ patients are Medicare beneficiaries. Moreover, Medicare patients are likely on the hook for more of the bill — co-pays APPROACH and drug expenses, for instance — when the hospitals are reimbursed at the outpatient rates. A boon in high-deductible health plans already has forced hospitals to up their game in collect- GAINS CRUCIAL ing unpaid bills, and the two-midnight rule SCOTT POLLACK would only intensify those efforts among See MIDNIGHT, page 24 MOMENTUM STORY BY KEVIN KLEPS n 30-second television commercials, the likes of Urban I Meyer, Archie Griffin, Thad Matta and Clark Kellogg proclaim themselves Cleveland Cavaliers.