Your Money Don’t Let Your Hospital Bill Cause a Heart Attack
Just when you’re starting to recover from your hospital stay, you get the bill, and those chest pains start to come back. But you don’t have to feel like you have no control over your health care expenses. You can take steps—both before and after a hospital stay—to ensure the best possible financial outcome. Click here to view article.

Don’t Let Your Hospital Bill Cause a Heart Attack

Just when you’re starting to recover from your hospital stay, you get the bill, and those chest pains start to come back. But you don’t have to feel like you have no control over your health care expenses. You can take steps—both before and after a hospital stay—to ensure the best possible financial outcome.

Admitted vs. Observed

One good way to make sure you’re not paying unnecessary costs is to pay attention when you first enter the hospital. Is the hospital classifying you as an admitted patient or just for observation? The difference can mean that you end up paying for your rehabilitative care.

Because Medicare considers hospital observation an outpatient service, it won’t pay for rehabilitation. Current Medicare law requires a patient to be in the hospital, admitted as an inpatient, for three days in order to receive coverage for rehabilitation in a skilled nursing facility. After that, Medicare pays for the first 20 days of rehab or other care. Conversely, if a patient has been under observation—for all or part of that time—he is responsible for the entire cost of rehab.

Because hospitals provide observation care on an outpatient basis, patients must usually pay co-payments for their doctors’ fees and each hospital service. In addition, patients must pay out of pocket for any medications the hospital provides for pre-existing health problems. Medicare drug plans are not required to reimburse patients for these drug costs because Medicare covers outpatient costs under Part B rather than Part A. This can mean paying more out of pocket for prescription drugs.

Because Medicare has strict criteria for hospital admissions and usually won’t pay anything for admitted patients who should have been observation patients, hospitals in recent years have increased their share of observation patients. Yet, a government investigation found that observation patients often have the same health problems as those who are admitted (Kaiser Health News).

Growing Trend

More Medicare beneficiaries are entering hospitals as observation patients every year. The number rose 88 percent over the past six years, to 1.8 million nationally in 2012, according to the Medicare Payment Advisory Commission, which helps guide Congress on Medicare issues (Kaiser Health News). At the same time, Medicare hospital admissions stayed about the same.

The Center for Medicare Advocacy filed a class action lawsuit against the federal government in an attempt to abolish the observation status—or at least for patients to be notified and given the opportunity to make a swift appeal against the decision. However, a federal court judge in Hartford, Conn., dismissed the lawsuit, which was filed on behalf of 14 Medicare beneficiaries who were denied nursing home coverage.

The trouble is that hospitals don’t necessarily tell you how you are classified when you first come to the hospital (and Medicare doesn’t require this). So you need to be proactive to make sure you are admitted rather than observed. (See sidebar, “How to Avoid ‘Observation’ Status” for actions to take.) To counteract the overuse of observation status, in August 2013 Medicare introduced a new regulation that will require physicians to admit patients whom they expect to be in the hospital for longer than two midnights. However, the so-called “Pumpkin Rule” has gotten so much resistance from hospitals that its implementation has been delayed.

Steps to Control your Hospital Bill

In addition to inquiring about your status when you enter the hospital, you can take steps to lower health costs before and after going to the hospital.

Plan ahead. If you have the luxury of planning a procedure or surgery (that is, it’s not an emergency or you’re not restricted to certain hospitals), you can find out which hospital is the least expensive for your procedure (and is within your insurance network). Surprisingly, some of the higher-rated facilities offer the least expensive procedures. Using the billing code (available from your doctor) known as CPT (current procedural terminology), you can check Internet sites, including FAIR Health, Healthcare Blue Book andNew Choice Health for rates local hospitals charge for your procedure.

Also, when planning ahead, you may need pre-authorization, so be sure to check with your insurance company.

A freestanding ambulatory surgery facility, which is less costly than the hospital, can do some elective procedures. Check with your doctor and insurer. If you need an anesthesiologist, find out if they are in the network, because they bill separately. However, if unknown, most plans will bill at the in-network rate.

Stay on top of bills. After the surgery and once you start getting bills from the hospital, make sure you stay organized. For example, you could have bills coming from the hospital, various doctors, the lab and the ambulance. Some won’t come from the hospital itself, but from the provider who performed a service.

Check all the bills for errors. For example, if the hospital discharged you in the morning, protest if the hospital is charging a full daily-room rate for the date you left. Similarly, make sure there are no charges for medications you brought to the hospital. Also, the hospital daily-room charge should include fees for routine supplies, such as gowns, gloves and sheets, and not be extra.

Negotiate bills. If you think your bill is out of line, you can check other hospitals’ rates for the same procedure and use that data to try to convince the hospital to lower your fees. You can also use Medicare rates as a guide. Even though the government program typically has the lowest reimbursement rate for hospitals and medical providers, the Medicare fees indicate the government value of that hospital service and provide a good starting point for negotiating.

Also, many hospitals are willing to work with you if you can’t pay the bill, either giving you extra time or lowering their fees. Most hospitals have generous financial-assistance programs to help trim large bills even if your household income is above the poverty line. If the hospital can’t help, public, private and nonprofit programs are available to help. The federal government’s website Healthcare.gov and the nonprofitNeedymeds.org offer information on patient assistance programs.

Get professional help. If you think you were overcharged, and you’re unable to make any headway with the hospital, you can get assistance from a medical or patient advocate. These often experienced medical billing professionals can step in and look for errors and overcharges in your bill and ultimately negotiate a lower rate. Typically, there is no upfront cost. The advocates charge anywhere from 15-50 percent of the money they save you, and some put a cap on their fees.

Some state governments, including Connecticut, Rhode Island and California, provide medical advocates. There are also nonprofit groups, like the Patient Advocate Foundation, that will negotiate on your behalf for free or a small fee. You can also find patient and medical billing advocates through the National Association of Healthcare Advocacy Consultants or the Alliance of Claims Assistance Professionals.

How to Avoid “Observation” Status

To prevent having to pay for skilled nursing rehabilitation after your hospital stay, AARP and Kaiser Health News recommend taking proactive steps:

• Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.
• Ask your doctor whether observation status is justified. If not, ask her to call the hospital to explain the medical reasons why you should be admitted as an inpatient. However, even if the doctor agrees, the hospital may be able to overrule that decision, or Medicare can change it later when reviewing the claim.
• After discharge, if you learn that Medicare won’t cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare’s home health care benefit or for Medicare-covered care in a rehabilitation hospital.
• If you have to pay for services at a skilled nursing facility, but you believe those services should have been billed as inpatient, you can try formally appealing Medicare’s decision. When you receive your quarterly Medicare Summary, follow the instructions to challenge the charges from the hospital listed under Part B of the notice. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter. Also challenge any charges from the nursing home for outpatient services such as physical therapy.
• If you are billed for care in the nursing home, ask the nursing home to submit a “demand bill” to Medicare. When it is rejected, you can appeal. The Center for Medicare Advocacy’s online “self-help packet” offers more details about how to challenge observation status.

  Source: “Medicare: Inpatient or Outpatient?” AARP; and “FAQ: Hospital Observation Care Can Be Costly For Medicare Patients,” June 18, 2014, Kaiser Health News.

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Your Health Hospitals Strive to Make Patients More Comfortable

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Even if you’ve managed to avoid hospitals for most of your life, as you age chances increase that you’ll require a hospital stay. But there may never be a better time to have surgery, because hospitals are working to be more responsive to patients. Click here to view article.

Hospitals strive to make patients more comfortable

Even if you’ve managed to avoid hospitals for most of your life, as you age chances increase that you’ll require a hospital stay. You may dread hospitals because you either know firsthand or have heard how unpleasant the experience can be. Popular stories often revolve around acquiring infections and getting sicker from being in the hospital, being discharged too early or not being able to get a good night’s sleep.

But there may never be a better time to be in the hospital, because hospitals are working to be more responsive to patients. Motivated partly by patient satisfaction surveys that are tied to Medicare payments and partly by increased competition, hospitals are taking action. They strive to make surgery safer and be more responsive to patients’ emotional comfort. Initiated in 2012 and tied to the Affordable Care Act, Medicare financially rewards the best-performing hospitals, based on the surveys. Because private insurers typically follow Medicare’s lead, it’s expected they, too, will eventually tie reimbursements to patient satisfaction.

In addition, hospitals are asking their nurses to complete more education and training, such as a bachelor of science in nursing and specialized certifications. Overall, hospitals are more likely today to value nurses’ input, as it is the nurse who has the most daily contact with patients and families. The goal is to facilitate greater whole-person care, which helps in the healing process.

Seeking Patient Input

The satisfaction survey asks patients about communication with doctors and nurses, hospital staff responsiveness, pain management, information received about medicines, whether the hospital was clean and quiet and about discharge and transition of care to a home or facility.

Because noise consistently gets the worst marks on patient surveys, hospitals are working to create a quieter environment. They are replacing overhead staff paging systems with wireless headsets, allowing patients to shut room doors and ask not to be disturbed, and installing white-noise machines and sound-absorbing ceiling tiles and carpets in rooms and corridors. In some units, routine checks of vital signs are not done unless necessary (from “Hospitals Work on Patients’ Most-Frequent Complaint: Noise,” June 10, 2013, Wall Street Journal.

Making Patients More Comfortable

Several hospitals are even working to reduce patients’ emotional distress that results from insensitivities in the care system. “The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real and pressing issue,” according to the New York Times (“Doctors Strive to Do Less Harm by Inattentive Care,” Feb. 17, 2015).

When medical staff started asking patients about causes for their distress, they heard about a doctor bluntly telling a patient he had cancer and the loss of privacy when a doctor discussed a patient’s medical condition where others could hear, a violation of HIPPA regulations, which can also place the hospital under risk of litigation. One hospital posted the patient satisfaction scores for its doctors, nurses and other workers, which galvanized the staff to improve their performance—and ratings.

Safer Surgery

At the same time, hospitals are trying to make surgery safer for patients. According to an analysis last year in the journal Patient Safety in Surgery, 46-65 percent of adverse events in hospitals are related to surgery, especially complex procedures (as reported in the Wall Street Journal, “How to Make Surgery Safer,” Feb. 16, 2015).

Not only are surgical errors harmful to the patient, but hospital finances suffer. One study reported that malpractice claims against hospitals over a 20-year period (1990-2010) resulted in $1.3 billion in payouts (Wall Street Journal). In addition, upcoming changes in Medicare payments (starting at the end of 2018) will base 50 percent of Medicare payments to doctors and hospitals on the quality of care they provide, rather than the quantity.

To track surgeons’ performance and learn best practices, hospitals are collecting more data about surgical errors. They’re educating surgeons about the equipment they use, as well as working to create a culture of safety in the operating room. On the patient end, hospitals are trying to predict which patients have the highest risk of complications from surgery or anesthesia. When patients are in poor health to begin with, hospitals may delay elective procedures until patients are stronger.

Avoiding Patient Readmissions

One reason for patient suffering—or at least inconvenience—is being discharged too early and having to return to the hospital for more care. Nearly 1 in 5 Medicare patients returns to the hospital within a month of discharge, costing Medicare $17.5 billion in additional hospital bills. Until recently, hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact benefit financially when patients don’t recover and return for more treatment. Generally, Medicare pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep.

But, in October 2012, Medicare began penalizing hospitals with excessive readmissions. As of October 2014, Medicare fined a record number of hospitals—2,610—for having too many patients return within a month, according to Healthcare Finance. Since the new regulations, many hospitals are working harder to provide patients with detailed instructions when they are discharged and to ensure that their recoveries are monitored and that they have an ample supply of necessary medications.

Guarding Against Common Hospital Errors

Hospital patients potentially face an assortment of medical complications, but you can be proactive and guard against problems. Before your hospital visit, write down your medications, the dosage for each and when and why you take them. Also list the dates and reasons for all previous surgeries/procedures.

Most important, don’t be afraid to challenge medical staff and ask questions. Experts say to never give up responsibility for your own health. WebMD advises how to deal with the six most common hospital complications. (See sidebar for suggested questions.)

1. Medication errors: To prevent getting the wrong medicine or dosage, ask the health worker what a medication is and why you need it before taking it. Make sure the nurse checks your ID bracelet against the name on the prescription.
2. Hospital-acquired infections: The Centers for Disease Control (CDC) report that, on any given day, approximately 1 in 25 U.S. hospital patients acquires at least one infection while in the hospital. Hospitals are full of nasty bacteria or viruses, including MRSA (methicillin-resistant Staphylococcus aureus), a type of staph infection that’s resistant to many antibiotics. To lower your risk, ask your doctor whether you’ll get antibiotics before and after surgery. After surgery, don’t let people touch you until you have seen them wash their hands.
3. Pneumonia: Pneumonia is the third most common hospital-acquired infection (after urinary tract and wound infections). To clear secretions in your lungs, breathe deeply.
4. Deep vein thrombosis (DVT): Surgery significantly increases your risks of DVT, which is a blood clot, typically deep in the veins of the leg. If the clot breaks free and travels through the bloodstream, it can get lodged in the arteries of the lungs, cutting off the blood’s supply of oxygen. This complication, called a pulmonary embolism, can be fatal. Fortunately, careful use of blood thinners can slash the risk of DVT without increasing your risk of bleeding. Because studies have shown that these precautions are often ignored, you should always ask about them. As soon as you are able, you can start moving around—stretching or walking—to reduce your risk of DVT.
5. Bleeding after surgery: You can help prevent uncontrolled bleeding by providing a list, before your surgery, of every medication you take—vitamins, supplements and homeopathic medication. Common medicines—like the painkillers aspirin and ibuprofen— can thin your blood, increasing the risk of bleeding. If you forget and take one of these drugs, say something, because a simple blood test can check if your blood is too thin for surgery. Also mention if you’ve ever had excessive bleeding, even for something minor, like the removal of wisdom teeth.
6. Anesthesia complications: Take precautions by meeting with your anesthesiology team to discuss your options. Go over the benefits and risks of local, regional and full general anesthesia.

Sources

“Medicare fines record number of hospitals for 30-day readmissions,” Oct. 03, 2014, Healthcare Finance

“Hospitals Face Pressure to Avert Readmissions,” Nov. 26, 2012, New York Times

“Medicare to Penalize 2,217 Hospitals for Excess Readmissions,” Aug. 13, 2012, Kaiser Health News

Ask Questions

In the hospital, don’t be afraid to ask questions about your care. Doing so could make your hospital visit easier and lets the staff know that you are actively engaged in your own health care. You can ask your nurse or other medical staff:

• How long do you think I will be in the hospital?
• What doctors and other medical staff will take care of my health?
• When will I see my doctor?
• What will be my daily schedule during my hospital stay?
• What will this test tell me? Why is it needed, and when will I know the results?
• What treatment is needed, and how long will it last?
• What are the benefits and risks of treatment?
• How long will I need the catheter? Can I get up and go to the bathroom with help or on my own?
• When can I go home?
• When I go home, will I have to change my regular activities or my diet?
• How often will I need checkups?
• Is any other follow-up needed?
• Who should I call if I have other questions?

From “Frequently Asked Questions,” NIH Senior Health

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Understanding behaviors can help caregivers manage Alzheimer’s disease stages

As Alzheimer’s and other dementias progress, behaviors change — as does the role of caregivers. While changes in behavior can be challenging, we have resources to help you through each stage of the disease.

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Brain scans may give clues to link between Alzheimer’s and Down syndrome

Research has shown that people with Down syndrome are at higher risk for Alzheimer’s disease. A new study suggests that changes in the brains of people with Down syndrome, as seen on brain scans, could help lead to treatments that could delay or prevent Alzheimer’s. People with Down syndrome have a chromosome that carries a gene that leads to the overproduction of amyloid, a protein strongly linked to Alzheimer’s disease.

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Reserve your Alzheimer’s awareness license plate

Share your support of the Alzheimer’s Association. Sign up for a specialty Alzheimer’s Awareness license plate, which will not only raise the profile of this critical cause, but generate funds and mobilize our leaders in government and citizens to prioritize Alzheimer’s. The Greater Illinois Chapter needs 1,500 reservations to begin production of the Illinois plates. Please reserve your plate today.

Alzheimer’s Association license plates are coming to Illinois. This is a incredible opportunity to raise funds as well as the profile of this critical cause and, in turn, mobilize our leaders in government and citizens to prioritize Alzheimer’s.

Funds generated by orders of the license plates aid the Alzheimer’s Association Illinois Chapter Network in its mission to provide care, support, education and awarness programs throughout the state. After the initial year, $23 of the annual $25 renewal fee goes directly to the Alzheimer’s Association.

Frequently Asked Questions

What will the license plate look like?

The design of the plate will not be created until all of the reservations are acquired. At that time, the Alzheimer’s Association will work with the Secretary of State on the design that will feature the Alzheimer’s Association logo and the colors white and purple. We will share the design once it has been approved and is ready for production.

When will I receive my new license plate?

The Association must obtain 1,500 reservations before the Secretary of State’s office will begin production. We are estimating 6 to 9 months before the plates are distributed.

Why am I paying $11 now when the plate is $25?

The fee is a deposit to reserve an Alzheimer’s license plate. Once the State begins producing the plates, you will be charged the remainder of the cost plus a ONE-TIME charge of $29 to switch from a standard to specialty plate. The Alzheimer’s Association incurs a cost for charging credit cards – the additional $1 covers this service charge.

What happens if I have recently renewed my license plates and paid for a current sticker?

You will not be charged for a new sticker. When you receive your new plate, you will also receive a replacement sticker with the same expiration month.

Is there an additional charge if I want to personalize my plates?

Yes, if you do not request specific letters and/or numbers, the cost will be $25. If you request a personalized combination of letters and numbers, there will be an additional ONE-TIME fee of $47. If you request all letters or less than three numbers, you will be assessed an additional ONE-TIME fee of $94. At renewal, the cost, no matter what type you chose, will ONLY be $25.

When will I be able to personalize my plates and/or can I keep my current plate number?

Yes, after the 1,500 reservations have been obtained, the Secretary of State will send you a letter, at which time you will choose the kind of plate you want. You can also elect to keep your current license plate number.

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