One of the worst parts of my job is to tell patients I am going to admit them into the hospital under observation status because I do not believe they have enough criteria to meet inpatient status. Why is this important? The Medicare rules for coverage are very different for observation than they are for inpatient hospital stays. Observation is considered outpatient. Medicare will pay for observation hospital services for up to 48 hours to allow physicians a chance to observe the patient and determine if they need to be admitted to inpatient status.
For patients admitted under observation status, Medicare will usually not pay for most routine home medications that are administered to the patient during their hospital stay. That means the patient will often get a large pharmacy bill from the hospital for hospital administered home medications. Hospital supplied and administered home medications can often run into the thousands of dollars for just a day or two stay in patients with dozens of medications.
I've been yelled at by families upset because the hospitalist had mom in under observation last month and they got a $1,000 bill for a bunch of her medications she would normally take at home. I always make sure I discuss this hole in Medicare coverage with patients and their families so there are no surprises when they open their mail a few weeks later. I give them the option of bringing in their own medications to be verified by the hospital pharmacists and administered by the nursing staff. I also give them the option of holding their home medications while they are in the hospital to avoid the large mark up in hospital supplied home medications.
I was able to hunt down this nice February 2011 summary from Medicare describing which medications Medicare will pay for during an outpatient observation hospital stay. Here's the first few paragraphs. Go read the rest of this resource so you can tell your patients the truth about what is and what isn't covered when the daughter drops dad off at 9 pm on a Thursday so she can leave town for the weekend (it happens more than you think).
Medicare Part B (Medical Insurance) generally covers care you get in a hospital outpatient setting, like an emergency department, observation unit, surgery center, or pain clinic. Part B only covers certain drugs in these settings, like drugs given through an IV (intravenous infusion). Sometimes people with Medicare need “self-administered drugs” while in hospital outpatient settings. “Self-administered drugs” are drugs you would normally take on your own. Part B generally doesn’t pay for self-administered drugs unless they are required for the hospital outpatient services you’re getting. If you get self-administered drugs that aren’t covered by Medicare Part B while in a hospital outpatient setting, the hospital may bill you for the drug. However, if you are enrolled in a Medicare drug plan (Part D), these drugs may be covered.
So Medicare Part D might be an out, however, don't count in it. Go read the rest of the link to see why. More than likely, the patient will get stuck with a bill for $200 worth of Tylenol.
For years, I was constantly confronted by patients upset that they couldn't take their own home medications while in the hospital because of hospital policy. And I would tell them up front that the hospital did not allow them to bring in their own medications as a matter of hospital policy. Safety was the reason given as medications coming on campus were difficult to verify across accurate identification, dose, storage and expiration. For safety purposes many hospitals don't allow patients to bring in their own medications. That leaves patients in a bind. This is a catch 22 for patients from a cost perspective. It's a catch 22 for hospitals from a safety perspective. What were the choices the patient then faced?
- Refuse to take their own home meds trying to be administered by the hospital at hospital based charges
- Doctors refuse to order patients' home meds because they know the financial hardship this will cause
- Patients' loved ones sneak in the medications behind everyone's backs as a way of bypassing the hospital's policies.
For years I have taken on little battles as a patient advocate to help get them the right to take their own home medications and not fall victim to massive uncovered pharmacy bills. I'm curious to know what other hospitals are doing in this situation to minimize the financial burden patients experience with "self administered" home medications during an observation hospital stay.