Until a policy solution is implemented, providers are left to identify local solutions. Four main strategies are being utilized: do nothing; allow patients to take their home medications (if they happen to bring them in); bill at a reduced rate; or not bill at all. The second option introduces significant logistical barriers because the Joint Commission and the Centers for Medicare & Medicaid Services both require medication verification, a time-consuming activity. After verification, medications typically still require specific orders, nursing involvement in their administration and documentation, and secure storage. Billing at the lowest contract rate or at hospital cost is another option that could mitigate patient fears but still leaves some potential exposure for those patients on many or particularly costly medications, and it does not account for the fact that patients already paid for the medication when they filled the prescription. Providing medications at no charge shields patients while shifting responsibility entirely to the hospital.
Reducing the exposure to this problem is a challenge to which no obvious solution exists. Advocating for our patients to find a workable solution and building a consensus across emergency physicians and nurses, pharmacists, and hospital administrators is no simple task. You should know how this issue is addressed at your hospital, and if a policy isn’t in place, now is the time to start working on one. If patients have not yet asked you how an observation stay will affect their out-of-pocket costs, just wait—one will soon.
Dr. Natsui is a Harvard-affiliated emergency medicine resident at Brigham and Women’s Hospital/Massachusetts General Hospital, in Boston.
Dr. Baugh is director of observation medicine in the department of emergency medicine at Brigham and Women’s Hospital.
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