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U.S. Sen. Charles E. Schumer seeks change in Medicare law

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Elderly hospital patients may see financial relief this fall if legislation is passed to allow observation status to count toward the three-day mandatory inpatient stay in order for Medicare to cover prescription drug and post-hospitalization nursing home care.

U.S. Sen. Charles E. Schumer, D-N.Y., visited Samaritan Medical Center on Tuesday to discuss his recently introduced legislation, “Improving Access to Medicare Coverage Act,” which would amend title XVII of the Social Security Act, and could take effect in October. As long as patients 65 and older are in the hospital for three days, their rehabilitation services would be covered under the change, and observation stays would “count toward the mandatory three-day inpatient stay for Medicare to cover prescription drug costs and skilled nursing facility services after a hospital visit,” according to a news release from Mr. Schumer’s office.

According to the news release, observation stays “are specifically, clinically appropriate services that treat and assess a patient in a hospital while a decision is being made as to whether patients will require further treatment as hospital inpatients, or if they are able to be discharged from the hospital.”

“The importance is seniors are stuck with these bills,” he said. “They have to find the money themselves.”

Mr. Schumer said that is often difficult to do, as many seniors are on a fixed income. The whole idea of Medicare, he said, is so seniors don’t have to make the choice between purchasing basic necessities and their health care needs.

Adams resident Audrey Garrett, 76, was admitted to Samaritan last year when she had knee pain, but was classified under observation status, as no operation or procedure was performed. She then had to pay $250 out of pocket for necessary prescription drugs, since Medicare would not cover those drugs because she was classified as in observation status. Mr. Schumer said he knows of an Albany-area man who had to pay $12,000 in bills because Medicare would not cover his rehabilitation because of the observation status.

Samaritan Chief Executive Officer Thomas H. Carman said the problem has heated up over the past year and a half, which aligns with implementation of the Affordable Care Act and its desire to reduce Medicare spending.

“I think it’s a way for the Centers for Medicare and Medicaid Services to put a lid on cost,” he said.

Mr. Carman said that when elderly patients get a bill from Samaritan, it puts the hospital in an awkward position because the hospital’s hands are tied with the current Medicare law.

Mr. Schumer called the situation “an unfortunate state of reality” and said it’s “leaving seniors high and dry.”

Jefferson County Legislature Chairwoman Carolyn D. Fitzpatrick said with the county’s aging baby boomer population, the situation is expected to become worse if the law isn’t changed.

“It’s not a fair law,” she said. “I don’t think it treats the elderly with respect.”

While Samaritan has received the brunt of the calls, a few also have come in to the Jefferson County Office for the Aging, according to its director, Peter J. Fazio.

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