Senators Confront CMS on Medicare Payment Policies
Senate Aging Committee Tackles Hospital ‘Observation Status’ Crisis | Appeal Academy
Senate Aging Committee Tackles Hospital ‘Observation Status’ Crisis
Senate Aging Committee Tackles Hospital ‘Observation Status’ Crisis | Appeal Academy
The U.S. Senate Committee on Aging held a hearing with two panels on Wednesday, May 20, considering the causes and possible solutions to the increased use of Observation services in hospitals, and the burdens placed on Medicare beneficiaries, in co-payments and loss of Medicare coverage for post-acute care. The hearing was attended by several Senators who have authored or co-sponsored several pieces of legislation now being considered by the Senate and the House.
Without directly saying so, the session effectively relayed the Senators’ conclusion that the two-midnight rule was likely increasing rather than reducing healthcare costs, especially when the impact of the 3-day rule is considered. Data mentioned suggests the 3-day rule actually costs more than having no such rule, and CMS evidently has NO data to show that the two-midnight rule has done anything but confuse patients and providers alike, raise costs to both beneficiaries and hospitals, and perpetuate this illogical status decision of Inpatient versus Outpatient, which makes no sense except as a way to merely *appear* to hold down costs of care.
The image at the top of this post is from an exchange between Senator Elizabeth Warren and the CMS representative, Sean Cavanaugh. The Senator noted that Mr. Cavanaugh had begun his testimony by talking about protecting the beneficiaries, how that is a key part of what CMS is trying to do, so she asked (something I wish I had thought to ask on an CMS Open Door Call):
“Has CMS evaluated how the changes in admission patterns caused by the two-midnight rule have affected out of pocket costs for beneficiaries?”
Senate Aging Committee Tackles Hospital ‘Observation Status’ Crisis | Appeal Academy
Mr. Cavanaugh tried to answer and was obviously uncomfortable, since he evidently could not answer the question… which Senator Warren actually called him on.
“I’m sorry Mr. Cavanaugh, that’s not answering my question.”
She repeated her question slowly, and asked if he had any data on how beneficiaries have been affected since the two-midnight rule was implemented.
His answer: “No I don’t.”
For a complete (blow-by-blow) review of the 90-minute hearing, see this article. Included are short video clips of the most important exchanges. During several of these, I found myself almost jumping up and down with delight because these Senators "get it."
Ultimately, the Senators were calling for CMS to eliminate the 3-Day Stay Rule, study further and possibly eliminate the 2-Midnight Rule, and fix all the confusion concerning the Inpatient vs. Observation Services issue, which none of them saw as a sensible or effective method of controlling costs, much less providing proper care for beneficiaries.
Personally, I doubt they will do little that the Senators are asking for, since CMS is in the Executive branch, and are not beholding to the Congressional branch.
The good news is that the Senate is in fact preparing legislation - the AFIRM Act of 2015 - to make some of the changes into law, thereby forcing CMS to act.
The bad news is that the Secretary of HHS, who ultimately runs CMS, will still be able to create regulations, interpret those (and the law, to some extent) pretty much as she/they see fit, and when she/they do, they are beyond Judicial review.