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Under observation in Riverside Regional Medical Center's new unit

MedicareAffordable Care Act (Obamacare)Riverside Regional Medical Center

I had not planned to test drive Riverside Regional Medical Center's new observation unit earlier this month. A bout of chest pain and constriction concerned my doctor's staff and I was told to go to Riverside's Emergency Department in Newport News. A colleague drove me there, and the emergency department staff quickly hooked me up to machines and hustled me through a series of tests. The heart was, and is, fine, but doctors wanted to make sure, so they asked me to stay the night in the hospital's new Observation Unit, part of the recently opened Pavilion surgical wing. The unit, which is adjacent to the emergency department, includes 18 rooms and is run by emergency-trained staff, who monitor each patient.

The first thing I noticed was the quiet after the bustle and beeps of the emergency department. I had a room to myself with a flat-screen television and spacious bathroom, but lest this sound like a hotel stay, I should note I was in a hospital bed and hooked up to cardiac and other monitors. The meals were heart-healthy (read, low salt) hospital fare. A team of four observation staff members, including a nurse practitioner, checked on me regularly. The bathroom was indeed nice, where the spaciousness allows those with disabilities who needed assistance such as a wheelchair or walker to move about easily.

Renee Roundtree, Riverside's vice president of emergency and trauma services, said the unit opened on April 15. The idea is to send patients from the emergency department to observation if they meet certain standardized measures, called InterQual criteria that call for short-stay monitoring. All beds in the observation wing are equipped with a range of monitors, including cardiac equipment. I can attest to that. Nurses also use hand-held electronic devices to measure various substances in patients' blood. That also cuts down on assessment time as they do not need to wait for results from the hospital lab. I had several blood tests while under observation and the staff knew the results within 10 minutes.

The use of observation units like the new Riverside wing has risen in U.S. hospitals, according to a number of surveys and federal reports. Kaiser Health News reports the number of patients in observation unit beds had risen to 1.6 million in 2011. More than half stay fewer than 24 hours, but many find themselves under observation for longer than a day, and in some cases observation can last several days. The concern, especially for patients who rely on Medicare, is that patients under observation are not admitted to the hospital. All services they receive in the unit are considered out-patient and are billed accordingly. Patients may find themselves paying several co-payments and the cost of medications and procedures Medicare or their insurance does not cover because they were out-patients.

"For in-patients there is a cap on deductions," Roundtree said. "As an out-patient the little tests could add up." But for a short observation stay the costs should be less than those for in-patients.

Critics of the rising number of patients funneled to observation beds rather than hospital admission point to another incentive. Under the Affordable Care Act, hospitals that readmit patients less than 30 days after discharge can face penalties in Medicare payments for services. That has led some medical centers to send patients to observation wings instead of hospital beds, to avoid the "bounce back" reductions.

Roundtree said Riverside does not use its observation unit to avoid readmission.

"If someone comes in and is a bounce-back, they are readmitted," she said. "Our physicians are not scared" of penalties. She said Riverside's readmission rate is lower than the state's average, so bounce back has not been an issue.

Roundtree said about 11 percent of Riverside's observation patients are admitted to the hospital. That's lower than the national average of 20 percent. But for those patients sent to observation for monitoring and extra tests, such as an echocardiogram, most are discharged about 13 hours after they enter. "Typically, to get out of the hospital after being admitted would take a day and a half," she said.

Currently the unit averages about five patients, but Roundtree said the number will increase over time. The empty beds can be used by the emergency department if needed, staff members said. The staff took good care of me and I was discharged after an overnight stay, but I hope my visit to Riverside's observation unit is a one-time event.

By Cathy Grimes, Daily Press.

Copyright © 2014, The Baltimore Sun
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