Dr. Don Berwick: Change Medicare Nursing Coverage Rule

Medicare should eliminate a coverage rule requiring at least a three-day hospital inpatient stay for beneficiaries to qualify for follow-up nursing home coverage, former CMS Administrator Donald Berwick, MD, told The Boston Globe.

don berwickMedicare only pays nursing home bills if the patient in question required at least three days of inpatient care. Because observation and admission can seem similar from a patient perspective, some people are surprised to find follow-up nursing care isn't covered and end up with medical bills they can't pay. That situation is "not fair or appropriate," Dr. Berwick told the Globe.

He said he discussed getting rid of the rule during his time as administrator from July 2010 to December 2011, but others at CMS expressed concerns that eliminating the requirement would result in people who didn't actually need the care checking into nursing homes. However, Dr. Berwick told the Globe Medicare could stop people from abusing the system through other measures, such as requiring a physician to verify the patient needs nursing home care.

Dr. Berwick is far from the only one who takes issue with the nursing home care coverage requirement. Sens. Chuck Schumer (D-N.Y.) and Sherrod Brown (D-Ohio) have also sought to tackle this issue and announced their plan last month to launch the Improving Access to Medicare Coverage Act, which would change how Medicare covers observation stays and long-term rehab. Under the proposed legislation, observation stays would count toward the three-day Medicare coverage minimum, in addition to inpatient stays.

More Articles on Medicare Coverage:
Readmissions Dilemma: Admit or Observe?
Senators Plan Reforms to Medicare's Observation Status
Ratio of Medicare Observation Stays to Admissions Increased 34% in 2 Years 

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