Gouging Seniors

An “observation” patient is technically never admitted and the visit counts as “outpatient care.” In that case:

These observation patients might wind up paying a larger share of their hospital bill than inpatients, since they usually have a co-payment for doctors’ fees and each hospital service. But Medicare doesn’t pay at all for routine drugs that observation patients need for chronic conditions such as diabetes, high blood pressure or high cholesterol…

In Missouri, several Medicare observation patients were billed $18 for one baby aspirin, said Ruth Dockins, a senior advocate at the Southeast Missouri Area Agency on Aging; Pearl Beras, 85, of Boca Raton, Fla., said in an interview that her hospital charged $71 for one blood pressure pill for which her neighborhood pharmacy charges 16 cents; In California, a hospital billed several Medicare observation patients $111 for one pill that reduces nausea; for the same price, they could have bought 95 of the pills at a local pharmacy…

More from Susan Jaffe in the Kaiser Health News.

Comments (4)

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  1. Devon Herrick says:

    This is a byproduct of the third-party payment system. Patients pay only about 3 cents on the dollar for hospital services. Hospitals would have transparent pricing if they were actually competing for patients. Only in a system where services are mostly covered by third-parties do these types of shenanigans thrive.

  2. Joe Barnett says:

    If Medicare paid for avoiding costs, maybe patients would have an incentive to go to a retail clinic or local pharmacy. It is reasonable, considering ED costs, for a hospital to bill “Medicare observation patients $111 for one pill that reduces nausea; for the same price, they could have bought 95 of the pills at a local pharmacy…” They could have admitted them, run up $10K in expenses, and given them the aspirin.

  3. Dennis Byron says:

    Someone — the author of the blog or the author of the Kaiser article — is missing the big picture, the difference in Medicare depending on whether you are admitted for three days (in which case Part A applies and there is an $1156 deductible) or simply observed for three days (in which case Part B applies and there is a 20% co-pay, perhaps $3000). $15 aspirin are the least of the senior’s worries.

  4. Harry Baughn says:

    Our eye care physician refuses to test both eyes for glaucoma on the same visit because he says medicare doesn’t pay him enough. He requires the patient to return for a second visit(and an additional copay) to get the other eye tested. His name is Dr. Marshall Wareham located at 5250 Far Hills Ave., Dayton, ohio