2. it up to the admitting physician and then holds the hospital
accountable if the wrong decision is made.
- So what are physicians supposed to do,
according to Medicare regulations? It's
actually pretty simple. If you believe the
patient's condition can probably be
stabilized and discharge (or a decision to
admit) may occur within about 24 hours,
the patient should be assigned to
observation status. Otherwise, inpatient
admission is usually appropriate.
- Documentation of this information can be
crucial in supporting your decision. By
including a note in the H&P that admission
for more than 24 hours is anticipated, you
may save the hospital a prolonged battle
with Medicare auditors trying to justify an
inpatient admission.
On the other hand, if you believe that discharge is likely
within 24 hours, say so and order observation status.
Should the patient require a longer stay, it is a very simple
matter to order an inpatient admission at that point. By
contrast, changing an inappropriate inpatient admission to
observation status is tedious and complicated.
In general, there are five circumstances to consider for
observation status:
Diagnosis, treatment, stabilization and discharge
are expected within 24 hours.
Treatment and/or procedures require no more than
24 hours to complete (weekends or other
scheduling delays are not sufficient reason for
inpatient admission).
Clinical condition is changing or improving such
that a disposition decision can be made within 24
hours.
It is unsafe for the patient to return home or to the
current care setting, and arrangements for a safe
discharge setting need to be made (unavailability
of lower level of care is not sufficient for inpatient
admission).
The patient is having an uncomplicated outpatient
procedure requiring extended care or observation.
In summary, patients who are likely to require 24 hours
or less for a disposition decision should be assigned
observation status. When in doubt, admit to observation
since conversion to inpatient status is a simple process.
Clearly document severity of illness in the chart at the
time of admission and reasons for continued stay.
Document to show the admission was medically
necessary.