credit David Plunkert

To the Editor:

Re “Under ‘Observation,’ Some Face Big Bills” (The New Old Age column, Science Times, Sept. 5):

Kudos to Paula Span for writing about the consequences of hospital stays under “observation status,” meaning “not admitted,” in relation to payment for nursing home stays after discharge.

As she mentions, Medicare reimburses less for outpatient services, including hospital stays under “observation” status, than for inpatient care for those designated “admitted.” Therefore, the high bills received after discharge from “observation” stays have a disproportionate effect on the meager savings of economically disadvantaged people, especially minorities.

Medicare’s “two-midnight rule” — applied when two days of inpatient care is deemed medically appropriate — is irrational and punitive because of its rigid criteria. For example, a patient may be treated for a serious condition like an asthmatic attack, cardiac arrhythmia or other acute problem in an I.C.U. and discharged after a one-night stay. Despite the level of care received, it would be treated as an “outpatient” stay.

The rule does not take into account the medical condition but looks only at timing — that is, when the patient has been appropriately treated in the hospital across two midnights.

Congress should act to change the “two-midnight rule” to eliminate its punishing effect on all Medicare beneficiaries.

BARRY B. PERLMAN, NEW YORK

The writer is a past president of the New York State Psychiatric Association and a past medical director of St. Joseph’s Medical Center, Yonkers.

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