Dr. Kavita Patel and John Rother
A fundamental principle of the American health care system has always been that your medical care is driven by two things: your own choices and your doctor’s judgment. It’s what’s right, and it’s what works.
But if a new rule proposed by the Centers for Medicare and Medicaid Services is finalized August 1, that principle will be undermined by removing provider judgment from the decision to admit a patient to the hospital. It’s a dangerous precedent that’s bad for the health care system, bad for providers, and bad for patients – and would cost hundreds of millions of dollars to implement.
At issue: How inpatient care for Medicare patients is covered. For years, CMS has used a variety of factors to determine whether inpatient care was medically necessary. Provider judgment – what a clinician thinks is best for a patient – has been central in this determination. Whether a patient would spend at least 24 hours in the hospital was another key determinant.