Should Hospitals Be Required To Tell Medicare Patients How Much An Outpatient Stay Costs? (H.R. 876)

What is H.R. 876?

(Updated March 12, 2018)

This bill was enacted on August 6, 2015

This bill seeks to improve the information given to patients about the cost of their care. Under it, Medicare beneficiaries under outpatient care for more than 24 hours would receive a hospital notice of:

• the difference between receiving care under outpatient observation and receiving care in a hospital and why the healthcare professionals made that choice;
• the effect this decision would have on Medicare coverage or other cost-sharing mechanisms.

The bill does not require, but would allow the Secretary of the Department of Health and Human Services to require that patients or those acting on their behalf sign the notification to show that they’ve received it. It also requires that the notification be written in plain language, and that people who would prefer to receive it orally can do so.

Hospitals would have to give 36 hours notice after placing a person under this care. If the bill passes, healthcare facilities would have one year to fully comply with the new regulations.

Argument in favor

Hospital care is expensive — and people have Medicare because they need help paying for it. If they are going to receive treatment that Medicare does not cover, they need to know so that they can plan accordingly.

Argument opposed

Doctors order treatments for patients, because they are necessary, not to make money. Outpatients are designated as outpatients because doctors believe it’s medically necessary. No amount of notification will change that.

Impact

People that qualify for Medicare; hospital outpatients under observation; doctors, nurses and other care providers; the Social Security Administration

Cost of H.R. 876

The CBO estimates that this bill would have no significant impact on the Federal budget over the next ten years.

Additional Info

In Depth:

This bill has bipartisan support, and amends the Social Security Act, signed in 1935.

Of Note:

If you’re in the hospital, you’re an inpatient, and if you aren’t, but are still receiving care, you’re an outpatient. Simple, right? Well, not really. You can still stay in the hospital as an outpatient if a doctor has you under observation — watching to see if you need to be admitted as an inpatient.

Currently, Medicare pays for twenty days in the hospital, but only if patients are there as “inpatients” for three. It does not cover on-site “outpatient” stays. This means that people who stay as outpatients can often get stuck with huge medical bills.

Media:

Co-Sponsoring Rep. Todd Young (R-IN) Press Release

CBO Cost Estimate

AARP (Context)