July 17, 2014

Hospitals Hurting Medicare Patients by Redefining “Inpatient” Care

by Levin & Perconti

Up until recently, one did not need to be a legal expert handling hospital related cases to know the difference between inpatient care and outpatient care. As traditionally understood, if you are receiving outpatient care you get to go home that day, and if you are receiving inpatient care, you have to stay in the hospital overnight. It has been a simple distinction. But hospitals are now blurring that distinction in a way that hurts patients, especially the elderly who after a life of hard work rely on Medicare to cover their medical expenses.

How Observation Status Hurts Patients

USA Today reported on this ongoing crisis earlier this month. It explains that under recent changes in the law, doctors have to certify that a patient has a serious enough condition to need at least two overnight stays for Medicare to cover an inpatient admission. However, patients are remaining in outpatient “observation” status for several nights in regular hospital rooms and not being admitted as inpatient-status patients. This becomes extremely costly to consumers because, while inpatient care under Medicare has a deductible, after that deductible is met the care is usually fully covered.

This includes coverage for medications and skilled nursing and rehabilitation facilities required after an inpatient stay. However, if a patient is classified as “outpatient” or as being in “observational status,” none of this aftercare will be covered by Medicare. That leads to thousands or even tens of thousands of dollars that Medicare consumers have to come up with out of pocket. And given that the definition of inpatient has always means “when you have to stay in the hospital,” patients usually have no idea that their aftercare is not going to be covered.

What Can You Do if a Hospital Puts You in Observation Status?

The Center for Medicare Advocacy has provided a list of things you can do if a hospital puts you in overnight observation status. The list includes the following:

***If the patient is still in the hospital:

1. Seek the doctor's help to “admit the patient as an inpatient.”

2. If the hospital insists on the patient remaining in observation status, as for written notice of the insistence.

3. If the hospital insists on the patient remaining in observation status, tell the hospital that you want to appeal that decision because the care is “medically necessary” and an “impatient hospital level of care.”

***If the patient is not still in the hospital, he or she might still be able to appeal. The patient will likely need the physician to assist.

One final note. The Center for Medicare Advocacy stresses that if the patient will need nursing home care after the hospitalization, it is particularly important that the hospital stay be categorized as an “inpatient admission.” If it is not, Medicare will not cover the nursing home care.

Related Posts:

Doing Your Homework, Researching A New Doctor

Healthcare Associated Infections: Alarming Statistics

July 15, 2014

What is Medical Malpractice? One Example is Leaving a Sponge Inside a Patient

by Levin & Perconti

Proponents of so-called tort reform claim that our medical malpractice system is overrun with “frivolous lawsuits.” They claim that crushing limits on what people can recover when they are injured by healthcare provider errors will in some way improve the legal system. So legislatures nationwide have put strict damage caps and statutes of limitations in place to prevent patients and their families from succeeding in medical malpractice cases. What this misguided mission ignores is the very real fact that actual people are severely injured by mistakes made in the medical profession. Just like truck drivers, plumbers, and restaurant service workers, sometimes some people in the medical profession do things wrong. And when they do, patients are either injured, or they die.

Medical Team Leaves Sponge Inside Woman

One such case happened in Ohio. The Dayton Daily News reports that Eugenia Snowden underwent a seventeen hour surgery in February 2009 at Miami Valley Hospital. During that surgery, the medical team left a laparotomy sponge inside Ms. Snowden's body. Ms. Snowden died fifteen months later. Wright State Physicians Inc. admits that the sponge remained in Ms. Snowden's body for about seven months, including two failed attempts to remove the sponge. One of the surgeries to remove the sponge wound up injuring Ms. Snowden's spleen. Ms. Snowden's husband filed a wrongful death suit due to what happened. The suit had gone to trial and a verdict is expected soon.

Continue reading "What is Medical Malpractice? One Example is Leaving a Sponge Inside a Patient" »

July 11, 2014

“Tort Reform” May Rob Quadruple Amputee of the Damage Award the Jury Determined to be Fair

by Levin & Perconti

Doctors are trained to provide us with necessary, sometimes life saving, health care. But even though most of the time doctors help their patients, sometimes they hurt their patients. When such medical malpractice occurs, the effects can be life altering for both the patient and his or her family. Recently a Milwaukee jury realized this, and awarded a woman and her husband $25.3 million. But misguided tort reform laws may deny the couple the money a jury said they deserve.

The Milwaukee Wisconsin Journal Sentinel reports that Ascaris Mayo, a mother of four, lost both of her arms and both of her legs in 2011 after doctors failed to detect a Strep A infection she suffered from. Mayo went to the hospital in 2011 for severe abdominal pain, a rapid heartbeat, and fever. She spent about nine hours in the hospital, and then was sent home with directions to see her gynecologist for “fibroid issues.” Only hours later, she collapsed at home due to the strep infection and subsequent septic shock. The septic shock ultimately led to the loss of all of her limbs because of damage to her vascular system. After a trial, where the jury heard the detailed evidence in the case, the jurors determined that a doctor and a physician’s assistant were responsible for the injuries because they failed to provide Ms. Mayo with alternative medical diagnoses that would have led her to pursue treatment. She was never told that a life-threatening bacterial infection was a possible diagnosis based on her symptoms—if she had been told, she would have sought further treatment.

Continue reading "“Tort Reform” May Rob Quadruple Amputee of the Damage Award the Jury Determined to be Fair" »

July 8, 2014

How the “Black Box” May Prevent Malpractice

by Levin & Perconti

We have all heard of the seemingly magical black box in airplanes. Nearly indestructible, the device tracks what happens inside the airplane in order to help experts determine the causes of airplane accidents so future accidents can be prevented. Now there may be a similar device that can help prevent personal injuries and wrongful deaths due to medical malpractice.

The Brampton Guard reports that a “black box” is tracking errors in a Toronto operating room. The device collected data that shows that surgeons are making the overwhelming majority of their errors during the same two steps of surgery, over and over again. Now researchers can take that information to try to develop ways to reduce those errors in the future, so that fewer patients wind up injured.

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July 4, 2014

Oregon’s New Approach a Better Solution than Malpractice Caps

by Levin & Perconti

Medical malpractice is a real problem nationwide. Due to missed or delayed diagnoses, health care provider errors, misread test and imaging results, and pharmaceutical errors, Americans are hurt every day. These sorts of medical mistakes can result in personal injury or even wrongful death. Therefore, preserving patients’ rights to both sue those who injure them and to recover for all of the damages they suffer is of vital importance.

Problems with Tort Reform

Unfortunately, over the last fifteen years there has been a misguided move in legislatures toward what has been called “tort reform.” Under the guise of battling so-called “frivolous” lawsuits, legislatures have enacted draconian laws that both severely limit the time frames in which injured parties can file suit, and slashed the amount of damages a plaintiff can collect. This of course has the exact opposite of the desired effect. Rather than hurting plaintiffs who are not injured, these laws most injure plaintiffs who have been severely injured. Those who are most injured may need more time to sue since after the malpractice it takes them longer to get back to any sense of normalcy, let alone contact an attorney. Additionally, those who are most seriously injured often suffer the most damages, and are the ones being prevented from a full recovery. What many Americans do not understand is that “tort reform” does not just affect medical malpractice claims they would call frivolous—it affects all claims, regardless of merit.

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July 2, 2014

Jury Awards $16.7 Million in Missed Diagnosis Case

by Levin & Perconti

Cancer is one of the leading causes of death in the United States. The World Health Organization stresses that early detection of cancer greatly increases the chances of successful treatment. An important part of early detection is proper screening, which is use of tests to identify individuals who have a disease. However, when a patient undergoes screening, such as a radiological procedure, and a medical professional misreads the test, the outcome can be catastrophic.

Importance of Proper Radiological Care

Radiological procedures help physicians get a better look at what is happening inside a patient's body. These procedures reveal conditions such as tumors, broken bones and internal bleeding. Doctors rely on the results of these tests in making a diagnosis. In order to save peoples' lives, the tests must be read properly to deliver a correct diagnosis that will lead to proper treatment. When they are not and a patient suffers injury, a delayed diagnosis or treatment, or a worsening in their condition, they may be able to file a medical malpractice suit to hold wrongdoers accountable.

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June 28, 2014

Healthcare Spending Expected to Rise in 2015

by Levin & Perconti

Regardless of one’s opinions of the Affordable Care Act or other options for healthcare reform, one thing we are all aware of is the seemingly constant rise in health care costs across America. Due to high student loan debt for doctors, malpractice insurance companies that price gouge their insured doctors, and patent protections of drugs and technologies, patients pay more and more each year. In medical malpractice cases, this means that not only do patients wind up paying more, but those whose carelessness hurts patients also wind up paying more to cover the costs of past and future medical expenses.

Growth Rate of Healthcare Costs is Going to Increase:

Now, however, the New York Times reports that consumers will be spending more on healthcare than ever before. The reason? Those who put off medical treatment during the economic downturn are finally seeking the care they put off for all those years. This information comes from a report from PricewaterhouseCoopers’s Health Research Institute, which predicts that medical costs will grow at a rate of 6.8% over all in 2015, compared to a rate of 6.5% in 2014.

This rate of increase was common before the economic downturn, but the growth of costs slowed while the nation’s economic troubles were ongoing. That is not to say that costs dropped during that period—only that they increased at a slower rate than normal.

The Washington Post reports that these numbers are based on interviews with healthcare industry executives, policy experts, and health plan actuaries. In addition to the improving economy leading to more people seeking medical care they put off, there are three other contributing factors:

-A growth in specialty drugs
-A growing trend of hospitals employing physicians directly
-Health systems’ investment in information technology, especially as large-scale consolidation takes place in the industry.

Factors are Limiting the Growth of Healthcare Costs:

The Washington Post also points out certain trends that are keeping costs from increasing at an even higher rate. These include:

-A greater focus on efficiency in healthcare
-A growth in high-deductible plans creating a different kind of health care shopper
-An expansion of payment models that give doctors incentives for keeping spending down.

How this rise in health care cost growth will affect insurance premiums is yet to be determined. The agency that conducted this survey also conducted a separate survey of employers. That survey found that a stunning majority—eighty-five percent—of employers have increased how much their workers pay for their care or are considering such increases. Additionally, there is a growth in employers pushing employees into high-deductible plans, which force the insured to shoulder the burden of a lot of typical health care ,and only kick in when health care costs become quite high.

See Other Posts:

Medical Malpractice Reform and the National Deficit

The Costs of Losing a Medical Malpractice Case

June 24, 2014

Failure to Translate Drug Information is a Prescription for Deadly Errors

by Levin & Perconti

Prescription drug errors are a serious cause of death and injury in the United States. As we reported earlier this year, Portland’s KATU found that 15,000 people are killed each year by prescription pills in the United States. The Food and Drug Administration (FDA) reports that medication errors kill at least one person every day in the United States, and injury 1.3 million others each year. These drug errors often result in lawsuits over personal injury or even wrongful death.

In a recent article, California Health Report described a different type of prescription drug problem that we don’t often think about that is becoming much more serious as our country becomes more and more diverse. According to the United States Census Bureau, one in five Americans speaks a language other than English at home. However, many pharmacies only provide drug information and instructions in English. And that English, especially the English regarding side effects and drug interactions, can be difficult to understand for even a native English speaker.

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June 20, 2014

No Recovery Against Hospitals for Family Woman Killed with Packing Left in Surgical Wound

by Levin & Perconti

Surgical errors can result in horrible consequences. This is particularly the case when something happens that should never happen in any surgery, like leaving surgical tools in a wound, or improperly packing a wound. However, even when these sorts of obvious errors happen, those who are injured (or their families in cases of death) are not always able to recover in court.

One example of this problem is a recent case from New York, Bucsko v. Gordon. While the court’s decision in the case was not released for publication, and thus has no precedential value, the facts of the case show how families can be prevented from recovering the damages they deserve as a result of the wrongful death of their loved one.

Continue reading "No Recovery Against Hospitals for Family Woman Killed with Packing Left in Surgical Wound" »

June 18, 2014

FDA Drug Event Data Now More Easily Available

by Levin & Perconti

Prescription drug errors hurt and kill people in the United States every year. Between pharmacists providing the wrong pills, doctors prescribing the wrong medications, and drug companies marketing unsafe drugs, the problem is staggering. The Food and Drug Administration (FDA) is the federal agency that has been charged with keeping track of complaints about medications. The FDA also announces voluntary recalls of medications when those recalls are initiated. However, up until now, the FDA has not provided the public with easy access to that information.

That is about to change. The FDA announced earlier this month that it is launching a “new initiative designed to make it easier for web developers, researchers, and the public to access large, important public health datasets collected by the agency.” This information will all be available at a new website titled openFDA. This new step toward transparency has been in the works for some time, but is being released just shortly after the Centers for Disease Control made their new treatment tracker website available, which is based on records of Medicare payments to doctors.

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