Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Upmc St. Margaret Opening 'Observation Unit'

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Upmc St. Margaret Opening 'Observation Unit'

Article excerpt

Beginning this week, patients arriving at UPMC St. Margaret Hospital near Aspinwall may find themselves directed to a newly designated "observation unit," where they will stay as physicians examine them, run tests and assess whether their chest pain or injured hip requires additional treatment.

But, make no mistake, even if patients in the 13-bed unit get X- rays, blood work or even stay overnight, that's no assurance they've actually been admitted to the hospital.

St. Margaret and several other local hospitals are addressing the growing number of patients whose stay Medicare considers an outpatient observation rather than a hospital admission -- and therefore reimburses the hospital perhaps one fourth what it would pay for an admission.

In a recent letter to primary care physicians, John Lagnese, a family care physician and St. Margaret's vice president of medical affairs, noted the average length of stay for observation patients is 1.6 days. "The goal is to try to keep the [average length of stay] to less than 24 hours," he wrote.

"This is a significant issue for the well-being of the hospital. It also should better meet the needs of our patients, most of whom would like to get out of the hospital as soon as possible."

Dr. Lagnese is not overstating the case.

In 2012, UPMC facilities saw a 21.7 percent increase in "observation" cases over 2011, while inpatient medical-surgical admissions were flat.

Regionally, the percentage of patients designated outpatient observations at Western Pennsylvania hospitals has consistently run above 20 percent.

The observation vs. admission designation can carry significant financial impact for patients, too, as many health insurance policies won't cover the cost of outpatient observations and the patient ends up paying the bill.

Medicare also will not cover follow-up nursing home care unless it follows a three-day hospital admission. If patients stay in the hospital for two or three days under "observation," they may be paying full fare if they need a skilled nursing care facility as they recuperate. …

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