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PTs have a role to play in battling a disturbing trend.

Imagine that at your skilled nursing facility (SNF) you are treating a patient who is 70 years old and received care at a hospital for a week before arriving. You discover that the patient had not actually been admitted to the hospital, but was there for "observation." As a result, you inform this individual that her stay in the SNF is not covered by Medicare, and that she most likely faces significant out-of-pocket expenses for her hospital stay.

The increased use of "observation status"—under which the facility determines that certain hospitalized Medicare patients are outpatients, even though the care they receive may be indistinguishable from that provided to individuals formally admitted as inpatients—has garnered significant public attention from patients, health care providers, and policymakers because it has serious consequences for patients and the health care system, including physical therapy.

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  1. Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673.html. Accessed April 15, 2015.
  2. Department of Health and Human Services Office of Inspector General. Memorandum Report: Hospitals' Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries, OEI-02-12-00040 (July 2013). http://oig.hhs.gov/oei/reports/oei-02-12-00040.pdf. Accessed April 15, 2015.
  3. MedPAC report to Congress. "Hospital Inpatient and Outpatient Services: Assessing Payment Adequacy and Updating Payments." http://www.medpac.gov/documents/reports/mar14_ch03.pdf?sfvrsn=0. Accessed April 15, 2015.

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