By now, I’m certain that most of you, in this audience are aware of the Medicare Outpatient Observation Notice. Otherwise known as the MOON, in some circles. For the uninitiated, the MOON is a new form that the Centers for Medicare and Medicaid Services (CMS), has mandated hospitals to provide to patients within 36 hours of beginning observation services as an outpatient. There has been plenty of consternation from hospitals and physicians concerning the roll out and implementation of this new rule from Medicare. The mandatory issuance of the MOON to both patients insured by traditional Medicare and Medicare Advantage, became official on March 8, 2017. The goal of the notice, as described by CMS, is to inform Medicare beneficiaries that although they may be in the hospital, they are outpatients receiving observation services, rather than inpatients. This is an important distinction that many of our patients and their family members are unaware of. And although we may disagree with the implementation of the rule, this is certainly a discussion that doctors and patients need to have.
What is observation? There is no absolute clinical definition of what qualifies as observation. However, observation services are generally considered to be clinical services provided to hospitalized patients, during a period of assessment and reassessment, to determine whether the patient meets the criteria to become an inpatient in the hospital or may be discharged to home. Under current CMS rules, Medicare beneficiaries in the hospital for observation differ from inpatients in two important ways. First, the observation patient’s presenting condition is not deemed to meet the medical necessity required for inpatient admission by the provider. Secondly, the provider feels that there is not an expectation that this condition will require medical care that will surpass two midnights.
This is now a conversation that hospitals must have with our patients. In my years of practice, I have had many patients inform me that they had never heard of observation. Since they were in the hospital they assumed that they had been admitted to the hospital as an inpatient. As physicians we understand that the failure to communicate effectively results in unrealistic expectations for the patients and their families. Though we may not be over the moon, about the MOON, I believe that it does provide an opportunity to have a much needed discussion.
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