Healthy World, Healthy Nation, Healthy You

Am I “Admitted or Not Admitted” from the Emergency Room? ~ Use of “Observation Status” versus Being Admitted as an Inpatient in an Acute Care Health Care Setting.

Linda M. Raileanu, RN, MM/PA, BSN
President/CEO
Genuine Healthcare Resources, LLC

Background:

LindaLinda M Raileanu is President/CEO of Genuine Healthcare Resources, LLC a patient advocacy and corporate health & wellness firm. She is a Registered Nurse with her masters in management / public administration, concentration in health care policy. Linda has over 24 years of diverse health care experience, spanning the hospital setting, managed care, the pharmaceutical industry, long-term care continuum, home health, and alternative medicine. She is also a certified Geriatric Resource Nurse through Penn State.

Linda and her team assist individuals and organizations with navigating through the complexity of the healthcare system from advocating for employees and caregivers to providing corporate wellness programs, especially given the intense changes coming due to the Healthcare Reform legislation, leadership in this area is critical.

She is also School Board Director of the West Chester Area School District.

Overview:

Although observation status has been around for quite some time, it is increasing significantly. Why? What has changed over the last two years to drive such behavior, which has caused many experts within the industry to share their concerns about its overuse and abuse?

Boston Globe:

These articles indicate how detrimental this can be, especially to the Medicare population.

This show will address the following issues, challenges, stories, solutions

  • Recent Over use and Abuse of Observation Status
  • Why? RAC Reviews & Readmission Penalties

3 Key Points:

  1. Definition of ” observation status” in an inpatient setting & how it negatively affects patients & families from a cost and use of services perspective
  2. . How RAC Reviews (Recovery Audit Contractors hired by the Center for Medicare and Medicaid Services) retrospectively reviews cases (over past 3 years) and enforces readmissions penalties and how this process plays a role in why hospitals are using “observation status” in lieu of admitting patients directly to an inpatient bed.
  3. Tips on what patients & families should do in this situation, including using an urgent care center for emergency conditions that are not potentially life threatening ( i.e. flu, sore throat, sprained ankle).

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