Observation Status

Sorry for the long hiatus–life intrudes.

Here’s an informative blog post by Dr. Bob Wachter (a founding father of hospitalist medicine) regarding “observation” status. You’ve undoubtedly been asked many times before whether an inpatient should have “inpatient” status or “observation”. This post explains the issue well, and references a recent paper by our very own hospitalist group, who found that many observation patients don’t meet the Centers for Medicare and Medicaid Services definition.

I’ve experienced this personally. About five years ago, I developed an acute L5 radiculopathy. I was howling in pain so much that my wife threatened to call 911 unless I agreed to go to the ED. So we (she) packed up the baby and I slid down the stairs and into the car somehow.

The ED doc gave me lots of opioids with little relief and then recommended admission for pain control, PT assessment, etc. The (non-UW) hospitalist wanted an MRI, which really wasn’t necessary but I wasn’t in a position to argue. Come to think of it, I don’t even remember getting the MRI, probably because of the effect of diazepam, which was what finally took my cramping and pain away. Oh, what a sweet relief that was–I remember that!

Anyway, I felt a little better the next morning. I was seen by a neurosurgery resident, who set up a follow-up appointment in his attending’s office. PT saw me twice over two days, providing a walker on the second visit; this finally allowed me to walk and thus be discharged.

When I received a $60 bill for the ED co-pay, I called my insurer because the co-pay is supposed to be waived if you get admitted. I was told that my stay was actually for observation and that I never was truly admitted. So, 44 hours in the hospital, including an MRI, neurosurgery consult, and two PT visits counted as “observation”. Kind of crazy, I thought, but it wasn’t worth $60 to spend hours arguing about it.

But for our neurology patients, who get hit with co-pays not only for an ED visit, but also for brain MRIs and everything else, there may be a lot of money at stake. So, please read the blog post linked to above and learn a little about the issue so that you can properly advocate for our patients.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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