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NYSARSC Conference June 7, 2018 Saratoga Springs, N.Y.

“Hospital Patient Rights: Understanding and Surviving New Policies for Admissions, Discharges, and Observation Status and How to Protect Your Rights”. NYSARSC Conference June 7, 2018 Saratoga Springs, N.Y. .

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NYSARSC Conference June 7, 2018 Saratoga Springs, N.Y.

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  1. “Hospital Patient Rights: Understanding and Surviving New Policies for Admissions, Discharges, and Observation Status and How to Protect Your Rights” NYSARSC Conference June 7, 2018 Saratoga Springs, N.Y.

  2. New York StateWide Senior Action Council is a grassroots membership organization made up of individual senior citizens and senior citizen clubs, and organizations from all parts of New York State. StateWide has a strong history providing outreach and education to senior citizens and their families since 1972 StateWide is the only state-wide organization in New York State that is governed by seniors and that advocates for seniors on a grassroots level. Overview (2)

  3. Programs Patients Rights Helpline – Toll free number to assist hospitalized and institutionalized patients and their families with their rights. MCCAP (Managed Care Counseling and Assistance Program) – To inform, educate and assist seniors and their families in making the best and most informed decisions regarding their healthcare in NYS. (8)

  4. Today’s Discussion- • Your Rights as a Patient in New York State • Preparing for a hospital or Emergency Room visit • How to compare hospitals, home care agencies and nursing homes. • How to find our information about physicians • Medicare Hospital Admissions, Observation Status and Readmissions Policies. • Mandatory Nursing Home Arbitration • Questions and Answers

  5. Hospitals Stays Can Be Disorienting

  6. Especially if you don’t have the information you need

  7. Being A Patient or Caregiver is Difficult WorkStay Organized…Stay Sane Tabs for all health providers: Hospital Surgeon Primary Care Doctor Specialists (ex. Vascular Cardiologist Endocrinologist) Dentist Rehab/Nursing Home Home Care TAKE YOUR STATEWIDE TOOL KIT TOO!!! Set up a Health Note Book  Appointments Calendar Your Discharge Planning Checklist Notes (write everything down) Contact Info Patient Providers Cards Caregiver(s) Insurance Cards Appeals numbers Medications/Prescriptions Preventive test dates (such as immunizations, cancer screening, cholesterol tests, diabetes screening , pap or prostate exams, etc.)  Test Results

  8. Emergency care vs. Inpatient care vs. Outpatient care • Emergency department care – classified and billed as outpatient care • Emergent and urgent care • Observation – classified and billed as outpatient care • Ambulatory care • Inpatient care = higher level of care • Intensive care units • Medical/surgical beds

  9. NY Dept. of Health responsible for responding to complaints for all patients Responsible for surveillance of acute and primary care facilities to assure compliance with Article 28 of the Public Health Law. Regulations allow individuals to register complaints about the care and services provided by hospitals and diagnostic and treatment centers.

  10. NY Patients Rights -No discrimination. -Right to emergency room care. -Right to know who is treating you. -Complete information about diagnosis, treatment and prognosis . -Right to participate in all health care decisions. -Right to refuse treatment. -Right to review you record without charge. -Right to challenge a bill. -Right to identify a caregiver to include in discharge plan and share information with. -Right to give informed consent for an order to not to resuscitate. -Right to make anatomical gifts. [Public Health Law(PHL)2803 (1)(g)Patient’s Rights, 10NYCRR, 405.7,405.7(a)(1),405.7(c)]

  11. CARE Act (Caregiver Advise, Record and Enable Act) • Hospitals are required to ask if you have a (effective April 23rd, 2016 ) • Patient can designate a caregiver • Caregiver does not have to be a spouse or family member-can be a neighbor or friend • The caregiver is entitled to education and information prior to discharge of the patient • Important to reduce readmission

  12. Veteran’s Bill (effective 12/8/16) • Benefits apply to all who have served in the military • Law makes clear that benefits are not dependent on war time service • If one has served, the hospital is obligated to provide information on Veteran’s benefits • “Information for Veterans concerning Health Care Options” fact sheet • https://veterans.ny.gov/sites/default/files/VA%20LOCATIONS.PDF • https://health.ny.gov/professionals/hospital_administrator/letters/2017/2017-02-16_dal_17-05_vets_law.htm

  13. Discharge Plan &Instructions • ED and Inpatient • Required to give instructions • What to do if symptoms come back • Refer back to MD if you have one • Identify follow-up care needed • Communicate with your primary care physician to notify them of any ED visit or admission

  14. NY State Dept. of Health must respond to complaints for all patients • Try to resolve a problem with your care provider but if that fails you can contact the state. • New York State Department of Health is responsible for the ongoing surveillance of acute and primary care facilities in New York State to assure compliance with Article 28 of the Public Health Law. Health Department regulations allow individuals to register complaints with the Department about the care and services provided by hospitals and diagnostic and treatment centers. • To initiate a complaint about a hospital or a diagnostic and treatment center, you may call the toll-free number at 1-800-804-5447 • Health Facility Complaint Form (https://www.health.ny.gov/forms/doh-4299.pdf)

  15. You may file a complaint in writing and send it to: • New York State Department of HealthCentralized Hospital Intake ProgramMailstop: CA/DCSEmpire State PlazaAlbany, NY 12237 • Questions or comments:  • 1-800-804-5447 • hospinfo@health.ny.gov

  16. Call LIVANTA for Medicare Hospital Discharge or Quality of Care Complaints or Assistance Examples of concerns or complaints: • A medication mistake • More information needed at discharge • A change in condition was not treated • Receiving an infection while in care Contact: 1-866-815-5440 Email: BFCCQIOArea1@Livanta.com Website link is: http://www.bfccqioarea1.com/mqhelpline.html Also can contact Medicare at: http://www.Medicare.gov

  17. Comparing Information on Health Providers HOSPITALS www.medicare.gov/hospitalcompare/search.html NURSING HOMES www.medicare.gov/nursinghomecompare/search.html CERTIFIED HOME HEALTH AGENCIES https://www.medicare.gov/homehealthcompare/search.html DIALYSIS CENTERS www.medicare.gov/dialysisfacilitycompare/  New York State Department of Health Consumer Health Care Information on Doctors, Hospitals and Nursing Homes www.nydoctorprofile.com/ https://profiles.health.ny.gov/hospital/index

  18. Medicare Observation Status:What is it?How do I know if someone has it?What can they do if they get it?Is it changing?How do we rid the planet of it?In the meantime what can we do?

  19. Example: • The Medicare patient with a broken hip can now be treated in the hospital under observation status and transferred to a nursing home for rehabilitation. • Unless they had 3 qualifying midnights as an inpatient they would find that they were responsible for the full cost of the rehab in the nursing home the cost of that care can be a tremendous burden. ($10-30,000 cost)

  20. Observation services include: • Short term assessment and reassessment • Services commonly ordered for patients presenting in an emergency room and who then need a significant period of monitoring in order to make a decision concerning admission or discharge. • Only in rare and exceptional cases are outpatient services supposed to span more then 48 hours

  21. CMS Finally Implemented a Limit on Observation Status Placement (3 years after first proposed)See: CMS’s MLN Matters Number: MM10080Related CR Release Date: May 12, 2017 Two-Midnight benchmark, Hospital stays are generally payable under Part A if the admitting practitioner expects the beneficiary to require medically necessary hospital care spanning two or more midnights and such reasonable expectation is supported by the medical record documentation. Medicare Part A payment is generally not appropriate for hospital Stays expected to span less than two midnights.

  22. It is paid for as a Part B Service • Being on observation means each service received in the hospital are subject to a co-pay of 20%. For example: the emergency room care, any tests, x-rays or MRIs, any physical therapy. Medicare has specific codes for observation status payment. • Any time spent on observation status does not count toward the 3 midnight requirement for coverage of any post hospital rehabilitation received in a nursing home. The patient is 100% responsible if not admitted as a patient for 3 midnights. • This happened to over 600,000 people in 2104.

  23. How does patient know if they have it? • HOSPITALS MUST TELL YOU!!! Thanks to legislation promoted by the aging network, as of January 2014 all hospitals in NYS are required to tell a person on Medicare in writing when they are being placed on Observation Status. • Effective March 8, 2017 all hospitals in USA are required to inform you with a Medicare Outpatient Observation Notice (MOON) See MOON form and guidance letter from NYS Department of Health forwarded to hospitals in April.

  24. Advice for Medicare Patients or Caregivers • Ask the hospital if you patient will be admitted as an INPATIENT or under OBSERVATION STATUS. • Don’t assume anyone will tell you ask and keep asking during your stay in a hospital. • If you are unclear you should ask admission staff, charge nurse, or patient advocate in hospital for information. If they can help call LIVANTA they are CMS’s designated Medicare Beneficiary Quality Improvement Organization to clarify patient status for you.

  25. What if someone gets it? • If a beneficiary is planning an overnight stay in a hospital they should discuss this with their primary care doctor. • It is best to challenge right away. • If aware of complexity of patient health needs should convey asap. Contact primary care doctor to help. • Ask if treatment will require any follow up rehabilitation in a nursing home. • Ask if they will be in the hospital 3 midnights in order for Part A coverage of such care.

  26. Observation Status Troubling Because of Cost and Lack of Recourse Catch 22 • Under normal circumstances protesting a “discharge” is difficult. The patient only has 24 hours to protest to the hospital and Livanta. • Rules for observation status are not clear. While the new regulations finally implemented to limit observation status for stays longer than 48 hours the patient recourse process still is unclear. • Increased out of pocket costs may have unintended consequence of speeding spend down of resources to Medicaid eligibility. • Fighting status change takes, time and resources.

  27. There are options: • If any follow up rehab care is going to be required (physical therapy or occupational therapy) ask if it may be done at home by a Certified Home Health Agency or a Hospital In Patient Rehab Facility. They can be paid for such care by Part A if it is medically necessary. • If so, consider this as an option and make sure it is included in the discharge plan and make sure beneficiary understands everything in their discharge plan.

  28. If care is denied: • If a nursing home says Medicare won’t cover you care for rehab, ask them to submit it to Medicare for denial so that you can appeal. You should receive a Notice of Exclusion from Medicare Benefits. • Can appeal the hospital charges for observation status if you feel you should have been admitted.

  29. An Observation Status and Appeals Brochure is available by calling StateWide’s Helpline at 1-800-333-4374 or going on our website at www.nysenior.orgIts Part of our Patients Rights Tool Kit

  30. To get help with an appeal: • A standard appeal process for “observation status” doesn’t exist since CMS does not consider the beneficiary as “admitted”. Challenging disallowed costs are lengthy and complicated process. • Observation Status Brochure available by calling StateWide’s Helpline at 1-800-333-4374 or going on our website at www.nysenior.org • Self Help packet available from Center for Medicare Advocacy : http://www.medicareadvocacy.org/take-action/self-help-packets-for-medicare-appeals/ • You can also file quality of care complaint with Livanta and they can check to see circumstances but Livanta does not have a formal appeal role in observation status cases.

  31. Examples and /Consumer Stories 33 • StateWide is collecting stories from individuals who experience difficulties with: • Admission • Discharge • Readmission • Reimbursement policies for hospital inpatient or outpatient care • Avoidable readmissions or transitions care • StateWide is sharing stories with policy makers to help improve systems of care.

  32. How do we rid the planet of it? It will take an act of Congress- • Contact your federal Senators and Representatives to support: S. 843/H.R. 1571 Improving Access to Medicare Coverage Act this would count anytime spent in a hospital toward the 3 midnight requirement for Part A coverage of post acute nursing home care. • CMS also needs to establish an appeals process through Medicare Quality Improvement Organizations (no proposal to do this yet).

  33. Reducing Readmission Rates • Supports from family/caregivers and community based services are critical in helping reduce readmissions. • Become familiar with the hospital discharge process and available navigator programs, and other community based resources. Use the Discharge Planning Tool. • Be visible and ask questions. • Speak up. Share information and note any changes that appear out of character. • Use programs like the patient navigators (at hospitals or cancer society), local Office for the Aging, New York Connects, Home Delivered Meals, Cancer Society Navigators, Care Giver Programs, EISEP, and other AAA services.

  34. Proposals to be Wary of: • Removal of appeal rights. • Vesting final decision making to providers, insurance brokers, insurance companies or managed care organizations. Right now Medicare and Medicaid beneficiaries have due process. • Doing away with Beneficiary Quality Improvement Organizations. • Eroding support for SHIP and LTCOP programs.

  35. If you hear of problems or have questions: • E:mail: www.statewidepatientsrights@gmail.com • Call: Patients Rights Helpline 1-800-333-4374 • Stay informed listen to our monthly Telephone Teach Ins (see www.nysenior.org for more information) Upcoming Telephone Teach Ins: • May 22 Lyme Disease Health Risks and Prevention  • June 19. Health Services for Older Refugees

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