Published October 09. 2013 4:00AM
At a time when bipartisan has somehow become a four-letter word in Washington, Democratic Congressman Joe Courtney of eastern Connecticut's Second District and Congressman Tom Latham, an Iowa Republican, deserve credit for doggedly reaching across party lines to try to correct a senseless and unfair Medicare rule.
For the third consecutive year, Reps. Courtney and Latham have cosponsored the Improving Access to Medicare Coverage Act. If passed into law, it would end a rule that in 2012 prevented more than 600,000 senior citizens from getting Medicare coverage for their doctor-ordered convalescent stays. That statistic is contained in a recent report filed by the Office of Inspector General for the U.S. Department of Health and Human Services.
The denial of Medicare coverage forces these seniors to choose between spending tens of thousands of dollars out of pocket for their convalescent care or returning home or to family, without getting the level of care the doctor advised.
At issue is the "observation status" designation. A patient admitted to a hospital for three nights or more is eligible to have follow-up, doctor-ordered care in a convalescent home paid for by Medicare. The exception, however, is if the patient is in the hospital for "observation." In those cases, there is no subsequent Medicare coverage.
Observation is a frequent designation when an elderly patient is very sick and in need of hospitalization, but the precise cause of his or her problems is not apparent and takes time to ascertain.
Increasing the likelihood of these designations is the potential Medicare penalties hospitals face when, in an effort to drive down costs, a subsequent government audit finds the medical staff declared someone an "inpatient" who should have qualified as under "observation."
"Hospitals have become increasingly concerned about these audits so they tend to come down on the side of observation status," Rep. Courtney said.
A federal judge last month dismissed a lawsuit challenging the rule. Legislation is necessary.
The Courtney-Latham bill would allow for the time patients spend in the hospital under observation status to count toward the three-day hospital stay requirement for convalescent home or skilled-nursing care under Medicare. A matching bill, introduced by Sen. Sherrod Brown, D-Ohio, is pending in the Senate.
The bills enjoy broad support among various advocacy groups, including the American Medical Association, the American Nurses Association, the American Association of Retired People (AARP) and the Center for Medicare Advocacy.
The Commission on Long-Term Care, created by Congress in 2012, included in its recent report support for the legislation. The commission focuses on the status of long-term care in this country for the elderly and for people with special needs.
Three years ago, the legislation had little support. It now, however, features 104 cosponsors in the 435-member House, including nearly two dozen Republicans. The potential cost of the rule change, which the Congressional Budget Office has yet to estimate, has limited Republican support.
To be fair, any such calculation should consider the cost of increased re-hospitalizations when patients, ruled ineligible for Medicare compensation, do not get the convalescent care they need and end up back in the hospital.
In any event, it is a breach of faith to deny so many elderly the financial support necessary to get the care doctors say they need.
Congress and the Senate should adopt the Courtney-Latham-Brown bills and President Obama should sign the legislation into law.