Are you in or are you out?

Better know when it comes to a hospital visit, because the difference could be hundreds or even thousands of dollars in unexpected medical bills.

According to state Rep. Stan Saylor, "a growing trend in the hospital industry" is to term a patient's short stay an "observation," rather than an "admission," thereby avoiding federal penalties or scrutiny for having a higher percentage of "re-admissions."

You might ask, "So what?" As long as the care is the same, what does it matter how a hospital terms a stay of a day or more?

It matters because Medicare and some other insurers consider observation to be "outpatient" care, so patients might have to pay out-of-pocket for tests while on observation, as well as any subsequent rehabilitation, said Saylor, R-Windsor Township.

Seniors – probably the least likely to be able to afford the unexpected costs – are the most likely to be shocked by this particular sticker.

Saylor is trying to alleviate some of the sting.

The state House recently unanimously passed a bipartisan bill he introduced that would require hospitals "to provide oral and written notice to the patient of their outpatient status after they have spent a full day in the hospital outside the emergency department."

It's a good start, but it doesn't really address the problem. An elderly person in distress shouldn't have to weigh whether they really need medical care once they know their full costs.

That's a doctor's decision.


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Patients do deserve to know their out-of-pocket obligations, and we support Saylor's legislation. But Congress needs to fix the real problem: Medicare.

If a doctor determines a patient's needs are serious enough to remain at a hospital more than 24 hours, it doesn't matter whether it's called inpatient or outpatient – Medicare should cover the costs.

Can't we just admit that?