I read with interest the recent article “Hospitals hope for relief from Medicare's two-midnight purgatory". Every time I see a story about the issue of observation services I feel compelled to reply. Quite frankly, it is the existence of observation services that is actually the problem. Any solution has to include the elimination of observation.
First and foremost, the presence of observation services has a negative effect on quality of care. Because of its availability, hospitals have to spend inordinate amounts of time, money and other resources trying to decide whether a patient who needs hospitalization should be observation or inpatient. A hospital like mine, which is a 250-bed community facility, might spend $1 million a year in personnel costs—highly trained medical personnel including nurses and physicians—determining whether a patient should be in observation or admitted as an inpatient.
If anyone feels that this price tag is an exaggeration, realize that it is a condition of participation with Medicare to have a utilization process to review for proper hospital status. These costs also include defending denials from recovery audit contractor reviews. For a community hospital, spending time and money on observation issues takes away resources that could have been used on quality and patient-safety issues.