CMS Reveals Medicare Appeal Process For Incorrect Hospital Observation Stays

Modern Healthcare: Hospital Observation Status Appeals Under Medicare Outlined
The Centers for Medicare and Medicaid Services has outlined an appeals process for Medicare beneficiaries who believe hospitals inappropriately classified their stays as observations instead of admissions. The proposed rule published Thursday aims to resolve a 12-year-old class-action lawsuit seeking redress for fee-for-service enrollees whose hospital or nursing home care wasn't covered under Medicare Part A because hospitals designated them as outpatients. (Bennett, 12/21)

KFF Health News: Cancer Patients Face Frightening Delays In Treatment Approvals 
Marine Corps veteran Ron Winters clearly recalls his doctor’s sobering assessment of his bladder cancer diagnosis in August 2022. “This is bad,” the 66-year-old Durant, Oklahoma, resident remembered his urologist saying. Winters braced for the fight of his life. Little did he anticipate, however, that he wouldn’t be waging war only against cancer. He also was up against the Department of Veterans Affairs, which Winters blames for dragging its feet and setting up obstacles that have delayed his treatments. (Sausser, 12/22)

In other health care industry developments —

Modern Healthcare: 50 Healthcare Mergers Challenged By FTC In 2022: Report
The Federal Trade Commission and Justice Department challenged 50 merger and acquisition proposals across all sectors of the economy in 2022, including six proposed healthcare deals, according to a new report. The FTC’s 24 merger enforcement challenges in 2022—including five in healthcare—marked the second-highest number over the prior 10 years, according to the annual report for the fiscal year ended Sept. 30 on the Hart-Scott-Rodino Act premerger notification program issued Thursday. (Kacik, 12/21)

NBC News: Vital Signs Vs. Dollar Signs: At HCA Hospitals, The Person Monitoring Your Heart May Be Doing It For 79 Other Patients. Is That Safe?
In Wesley Medical Center, and in most hospitals today, the people monitoring patients’ heart rhythms, blood pressure or respiratory functions are not nurses who interact with them. They are “telemetry” technicians who are supposed to alert those nurses to meaningful changes in the vital signs transmitted by electronic devices hooked up to the patients. The technicians in telemetry units typically watch screens showing heart rhythms and numbers for many patients at a time — sometimes dozens — and often sit in a room far from the patients they are watching. (Morgenson, 12/21)

Stat: Keeping Primary Care Docs In Field Isn't Impossible, Says AAFP CEO
In ten years, the United States could be short as many as 48,000 primary care doctors. The specialty is underpaid, to a point that doctors are lobbying Medicare to pay it extra. Even medical residents who chose the specialty are leaving primary care; some 45% of residents who planned to be generalists changed their mind during their residencies. (Trang, 12/22)

NPR: Shortage In Primary Care Clinicians Eroding Patient Trust
First, her favorite doctor in Providence, R.I. retired. Then her other doctor, at a health center a few miles away, left the practice. Now, Piedad Fred has developed a new chronic condition: distrust in the American medical system. "I don't know,'' she said, eyes filling up. "To go to a doctor that doesn't know who you are? That doesn't know what allergies you have, the medicines that make you feel bad? It's difficult...I know that I feel cheated, sad, and like I have my hands tied.'' (Arditi, 12/22)