News | Published February 14, 2014 | Written by Jacqueline Hahn, RN, BS, CPUR, CCM, director, case management, Mount Nittany Medical Center

The ins and outs of observtion status

Although outpatient observation stays are now commonplace in hospitals, you may be unfamiliar with what it actually means to you, the patient.

Observation Services are defined by the Center for Medicare and Medicaid Services (CMS) as a set of specific, clinically appropriate services that include ongoing short-term treatment, assessment, and reassessment that are provided while a decision is being made regarding whether patients will require further treatment as hospital inpatients, or if they are able to be discharged (sent home) from the hospital. It is common for observation services to be ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision about admission or discharge.

While under observation care, your room can be located anywhere in the hospital. The quality of care is exactly the same regardless if you are an observation patient or inpatient admission. Observation status and services are typically ordered for conditions that can be treated in 48 hours or less, or when the cause of your symptoms has not yet been determined. Although we typically strive for a maximum of 48 hours, observation can extend beyond two days. Some common examples of scenarios that would be appropriate for observation services may include abdominal pain, nausea, kidney stones, atypical chest pain, or dizziness.

An observation stay at the hospital is billed under outpatient services, Medicare Part B or your commercial plan. Since observation stays are billed as an outpatient service, your insurance co-pays and deductibles, along with any additional costs, will be based on the terms of your insurance policy.

At the end of your observation stay, your physician will decide whether to discharge you from the hospital or to admit you as an inpatient. If you get admitted to an inpatient stay after a period of observation, the entire hospitalization will convert to an inpatient admission.

At Mount Nittany Health, open communication between clinicians and patients is key. For patients at Mount Nittany Medical Center, caregivers make every attempt to communicate hospital status, so that you are aware of your care plan. The Case Management team is available to assist with any questions regarding status while staying in the hospital.

Additionally, we welcome questions from patients or family members about inpatient or observation status at any time. For more information, please visit us online at mountnittany.org.

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