Thank you for Stacey Singer’s thoroughly researched “Hospitals dodge admitting seniors,” about how “observation status” affects elders who find Medicare won’t pay for subsequent skilled nursing care if the patient technically was not admitted to the hospital for three days.
This is a nationwide problem. The patient you described — a frail, confused, 96-year-old in pain but refused hospital admission — is a classic example of a flawed system. I have a similar patient in the hospital now.
Traditionally, observation status was an easily predictable 24-hour stay or less. Typically, a patient with chest pain stayed until clearly there was no serious cardiac problem; or a patient with diarrhea who needed hydration to get through a self-limiting illness.
Observation is not, in my opinion, for a patient with a fracture who cannot now bathe, dress, use the toilet or get to food.
Hospital case managers work within a specific set of guidelines, which they use to determine which patients should be “observation” and who should be inpatient. As you so well stated, hospitals defend their position because of audits designed to take money away from them.
Physicians and hospital caseworkers are frustrated. The system for these frail elders needs fixing as regards the mandatory three-day inpatient stay prior to getting into a skilled nursing facility for rehabilitation.
DANIEL FORTIER, MD CMD FACP
West Palm Beach
Medicare dictates patient status
Your article“Hospitals dodge admitting seniors” did not portray the whole reality concerning Medicare and “observation status.” As director of case management in a Palm Beach County hospital, we struggle day in and day out to qualify patients for inpatient status.
That’s correct — “qualify for inpatient status.” You attributed the decision to the physicians and/or the hospitals. In reality, Medicare decides whether the patient is admitted to the hospital or has observation status. Medicare sets screening criteria to determine the admission status of the patient. This set of criteria is called InterQual. The patient’s status is based on the severity of the illness and the treatments ordered. The physician’s order for “inpatient” or “observation” must correlate to the criteria.
The three-night-stay rule to qualify for a skilled nursing facility should be deleted from the Medicare law. We struggle with this daily with our patients. How can we send a 90-year-old patient home who can’t walk, lives alone, has no family or resources and is not able to care for herself? We can’t. Medicare does not consider that an issue, but for us caregivers, who have to sleep at night, we are forced to either keep the patients in the hospital longer or the hospitals have to pay and provide the services to the patients in their homes.
Please, Congress, get rid of that three-night stay rule so that all the case managers can sleep again.
Female turtle should be called ‘she’
As a Palm Beach County native, I appreciate your excellent summer series focusing on Florida’s natural self. “On the trail of turtles” featured a spectacular photograph of a nesting leatherback – a magnificent creature laboring on one of our own beaches, laying her eggs, perpetuating her ancient species. It beautifully conveyed how lucky we are to host this impressive natural phenomenon.
Unfortunately, the photo caption referred to “a leatherback turtle, as it nests on the beach.” The caption was insensitive to the regal dignity of the nesting female, who deserved to be referred to as “she” rather than “it.”
My sensitivity to this issue was heightened by having been privileged to witness the rare daytime appearance of an awe-inspiring female leatherback pulling herself up on the beach at Ocean Ridge on May 30, 2012, an experience I will never forget. She is ancient. She is actively birthing. Please, give her the respect she deserves.
Snowden, Manning are American patriots
Edward Snowden and soldier Bradley Manning are true American patriots. They refused to be tools of the illegal, immoral and criminal activities of the U.S. government. Both Americans decided to protect our sacred right of free expression and democratic freedom. The intervention of our electronic mail and phone calls is an intolerable and nasty activity of the new electronic totalitarian state born after the Sept. 11 attacks, a “nasty job” carried out by the United States government.
JULIO CARLOS PEREZ
West Palm Beach
CEOs show ‘trickle down’ just a myth
So the average executive pay rose 24 percent! (“Head of FPL Parent Earned $33 Million.”) What did the average American worker get in the way of a pay raise this year?
Just when are Americans going to wake up and put Reagan’s “Trickle Down Economics” alongside Santa Claus and the Easter Bunny?
West Palm Beach
Profit, not safety, drives traffic cameras
Do I understand this correctly? The Village of Palm Springs is going to dismantle their red light cameras? They are not renewing their contract with American Traffic Solutions because it became a little more costly to prosecute motorists contesting their tickets.
The village, along with others in Palm Beach County, now has to set up a special “magistrate” to oversee the red light ticketing process. It has now become too costly for the village to continue the program that was instituted to deter accidents and make our roads safer. Now that it is not profitable and it might actually cost the village a few bucks, they are willing to sacrifice the safety of the motorists as they drive through these intersections notorious for red light running. Pardon me, but am I the only one to see the hypocrisy here?
Actor’s portrayal of Italians still galls
While my condolences go out to the James Gandolfini family, I remain hurt and insulted at the manner by which Italians were depicted in his hit TV series. No other race, ethnic, religious, or gender group would have allowed the media entertainment complex to destroy them as did The Sopranos.
The heritage of the proud Italian legacy given to America was ridiculed, mocked, debased. My paternal relationship to the Italian Catholic culture was deeply hurt over and over by this man’s television images. Please consider the harm done by this show. I’ve been one half Italian all of my life, and I do not know anyone like these New Jersey stereotypes. How cruel. How unfair.
Port St. Lucie
Stop needless risk to firefighters
Crystal Kolden’s commentary “Firefighters shouldn’t die to save homes” was right on. No one should ever die to save a house. We need to stop asking firefighters to place themselves in harm’s way. Wildfires are not going to stop happening. These young family men and women sacrificing their lives for something that can be rebuilt is insulting to the concept of life. Please stop this madness.
Time to revamp U.S. Supreme Court
Too many Supreme Court decisions that affect us all are decided 5-4, mostly along party lines, it seems. Perhaps it’s time for a constitutional amendment that mandates that the justices must deliberate until they can come to a unanimous decision or let the lower court decision stand.
I don’t know if this is viable, but it would certainly eliminate the ambiguity that exists now. We allow hung juries in our lower court system, why not at the highest court in the land, which, unfortunately, has lost the moral high ground that it used to occupy?
We know that, usually, the four conservative justices will vote to suppress liberty, the four liberal justices will vote to expand liberty, and that Justice Anthony Kennedy will usually decide the issue. And the current court has the lowest approval rating ever. This is no way to decide the most important laws in the nation.
Palm Beach Gardens