The Journal Gazette got my attention with the article VA center closes inpatient wards (Oct. 24) and the editorial Area’s vets get another nasty shock (Oct. 28).
The Department of Veterans Affairs may be looking to control costs by using processes similar to those required by Medicare. The words improving our processes may mean that the new process requires several categories of patients who all share the same facilities. Inpatient units would no longer be required. The Medicare rules require hospitals to use some type of screening process to determine the status (category) of a patient. Elderly people with medical problems are finding that they are in a difficult situation. Medicare rules and the profitable association of hospitals with nursing homes are hurting patients financially.
A utilization committee must determine status when a patient enters the hospital. Utilization committees are not necessarily composed of all doctors. The screening process relies on formulas using factors such as patient age, medical history and conditions present and important but not immediately obvious. A virtual doctor using a formula and the data supplied can make the status decision for the utilization committee. The virtual doctor may follow a flowchart that represents the sequence of actions required. The first action is to answer the question Does the Condition require hospital Treatment? with a yes, no or maybe. The virtual doctor must then answer new questions on three branches of the flowchart.
Medicare patients are becoming familiar with some business and manufacturing jargon. They defiantly hear the terms observation status and utilization. Observation seems to be the default status that most Medicare patients receive after screening. Utilize is business jargon that is often found when the meaning intended is simply use. A patient might feel utilized when they are presented with a discharge plan.
The quality of care and treatment of a patient would be the same whether a Medicare admission is inpatient or observation status. The difference, for patients, is out-of-pocket cost.