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Schumer's Plan Would Change Rules on Observation Status & What NY Seniors Must Pay -- In WNY 270,180 Medicare Recipients, in Hudson Valley 378,802, In Central NY 194,276, Rochester Finger-Lakes 226,622 Recipients

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Today, during a conference call, U.S. Senator Charles E. Schumer pushed his plan to change a flawed Medicare law, so that seniors with Medicare across Upstate New York are not charged unfairly for receiving needed nursing home care after being hospitalized. Schumer noted that "observation stay" cases in hospitals, when the elderly individual is not technically an inpatient, have been on the rise in recent years, costing America's seniors thousands of dollars in medical bills for post-hospital therapy and rehab. Currently, Medicare will only cover post-acute care in a skilled nursing home facility if a beneficiary has three consecutive days of hospitalization as an inpatient. Schumer pushed his plan, the Improving Access to Medicare Coverage Act, which would allow "observation stays" to be counted toward the three-day mandatory inpatient stay for Medicare to cover rehabilitation post-hospital visit.

Nursing home stays in New York cost an average of $356 per day, and a high of $528 for semi-private rooms, according to the 2012 MetLife Market Survey of Nursing Homes. This is the daily baseline cost, plus the cost of rehab and therapy services that seniors could be forced to pay. Schumer highlighted that without this change in Medicare law, an unexpected trip to the hospital could cost Upstate New York seniors thousands of dollars.

"In recent years, there's been a huge uptick in elderly patients under "observation' status at Upstate New York hospitals -- and it's leaving seniors high and dry and hospitals no better off. A flawed part of Medicare law is to blame, and I have a plan to change that, so New York's over 3 million Medicare beneficiaries are not at risk of being hit with huge rehabilitation bills after a lengthy hospital visit. This new Improving Access to Medicare Coverage Act would allow senior citizens to count time spent under this "observation status' towards Medicare-covered rehabilitation. If you are holed up in a hospital bed for days on end, it shouldn't matter what your billing status is, and this plan help will save Upstate New York seniors thousands."

Schumer highlighted the spike in observation status admissions in the past few years, in New York and across the country. The number of observation cases has been on the rise in recent years, a consequence of policies meant to reduce Medicare expenditures. According to most recent data from the American Health Care Association, New York average for observation stays was 29 per 1000 Medicare admissions in 2009, up 32% since 2007. This number has likely risen dramatically since. This can lead to massive bills -- in the tens of thousands of dollars -- that senior citizens must unexpectedly pay for rehabilitation and nursing home care post-hospital visit.

Schumer launched his fight for the Improving Access to Medicare Coverage Act to address the flawed Medicare law, sponsored by Senator Sherrod Brown (D-OH). Currently, Medicare will only cover post-acute care in a skilled nursing facility if a patient has three consecutive days of hospitalization as an inpatient, not counting the day of discharge. Unfortunately, patients are being placed in "observation status" while staying at the hospital and may unknowingly be treated under outpatient "observation status" for the entirety of their hospital visit. This then makes the patient ineligible, under Medicare law for Medicare-covered services such as stays in a nursing home or home care visits.

Under Schumer and Brown's legislation, "observation" stays will be counted toward the 3-day mandatory inpatient stay for Medicare coverage of skilled nursing facility services after a hospital visit. The Improving Access to Medicare Coverage Act of 2013 would amend title XVIII of the Social Security Act and ensure that patients 65 and older are eligible for coverage for their rehabilitation services, as long as they are in the hospital for three days.

"Observation" stays are specific, clinically appropriate services that treat and assess a patient in a hospital while a decision is being made as to whether patients will require further treatment as hospital inpatients, or if they are able to be discharged from the hospital. Hospitals in New York are following a flawed Medicare law in their treatment of many patients above 65 years old. In fact, Schumer noted, that hospitals are reimbursed less from Medicare for the treatment of patients under "observation status" than those that are inpatient. Hospitals also devote a significant amount of time and money to assuring that patients are properly classified as inpatients or outpatients.

Schumer's efforts follow dozens of reports of Upstate New York constituents who were categorized under "observation status" and unexpectedly forced to pay large rehabilitation bills. For example, Mr. Ike Cassuto from Albany recently broke his pelvis and spent four days at St. Peter's Hospital. In accordance with current law, St. Peter's listed him under "observation status" because no operation or procedure was performed. The consequence of this meant that Medicare will not pay for his 3-weeks in rehab that followed his hospital stay. Schumer emphasized it is the flawed Medicare law which is costing seniors thousands of dollars.

Earlier this month, the Greater Rochester Area Partnership for the Elderly met to discuss the implications of observation status versus inpatient hospital admission. During their meeting, attendants discussed the importance of federal legislation to allow time spent in observation to count toward Medicare-covered rehabilitation. Last September, an elderly Rochester woman in her 80s was treated for heart attack symptoms and had to pick up the tab because she was admitted under "observation" instead of "inpatient" status. In August, a 93 year old Victor, NY woman who was treated at the hospital after falling from her bed and suffering from vomiting and headaches unexpectedly was saddled with a bill in excess of $20,000 for hospital and rehab charges due to the fact she was admitted under "observation" status.

On the call, Schumer provided a breakdown of New York Medicare beneficiaries:

In the Capital Region, there are 159,860 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.
In the Western New York, there are 270,180 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.
In the Central New York, there are 194,276 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.

In the Rochester-Finger Lakes Region, there are 226,622 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.

In the Hudson Valley, there are 378,802 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.
In the Southern Tier, there are 151,561 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.
In the North Country, there are 103,479 Medicare beneficiaries who could be on the hook for an average of $356 per day in nursing care, plus cost of rehabilitation and therapy services.


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