New York Emergency Room Doctor Talks About Being Under Observation

Posted on: July 8, 2013

Are You Under Observation?

By Dr. Eugene Spagnuolo, Associate Director of the Emergency Department, Northern Westchester Hospital.

JVEC0031You might assume a trip to the emergency room that turns into an overnight stay means that you’ve been admitted and are receiving inpatient care, but that’s not always the case. If your doctor has placed you under “observation,” you’re technically an outpatient. That distinction is critical because the difference between being observed and being admitted can have a big impact on how your stay is covered by insurance and may impact your out-of-pocket expenses.

What is Observation?
Sometimes patients arrive at the emergency room with vague symptoms. They may have fainted or have chest pains. Observation is an outpatient service that allows your doctor to place you in an acute care setting, within the hospital, for a limited amount of time to monitor your condition and determine if you should be admitted to the hospital or can safely return home. In some cases, the patient’s diagnosis can be clear — asthma, for example, or pneumonia — but the patient only needs clinical care and observation until symptoms improve.

All patients who come to the Emergency Department are evaluated and a determination regarding the need to place them in observation status is made. Observation also applies to all insurance types and to self-pay patients.

What is meant by “for a limited amount of time”?
Observation is typically between eight and 48 hours. It usually applies when further testing and monitoring is necessary to determine a diagnosis, and when the length of stay is expected to be under two or three days. Observation services are based on your medical need as determined by your physician.

Does observation cost the patient more than being admitted? 
Observation is billed differently than an admission. While admissions are billed under Medicare Part A, observation is an outpatient service and billed under Medicare Parts B and D. Private insurers also have different methods for billing observation patients. Observation care costs less, which sometimes, but not always, translates to a lower charge for patients.

How does Observation affect my co-pay?
Because observation is an outpatient service, outpatient co-pays and deductibles apply as per your insurance benefits.

Why do doctors use Observation?
When patients arrive at the emergency department, they are expected to have a relatively short stay. Typically, eight (8) hours is considered to be the upper limit. Admissions, however, can last days. Unfortunately this creates a time period where neither status applies to patients, and during which many patients can be evaluated, or treated and safely discharged. Observation is used for this time period. Observation units were created with the first Emergency Departments in the 1960’s when Emergency Physicians recognized this need. It is only recently that insurers have recognized this need, the benefits of shorter patient stays, and reduced cost. Additionally, several studies have shown improved patient outcomes in observation units.

What kind of medical problems do people have that make Observation appropriate?
Many types of clinical problems support the need for observation. These include symptoms that are typically resolved within a day. Examples are nausea, vomiting, weakness, stomach pain, headache, kidney stones, some breathing problems, and certain types of chest pain.

What is the difference in the quality of services and care in Observation?
None. You will be cared for by qualified medical and nursing staff, and will receive the same quality clinical care as any patient in the hospital.

What happens at the end of 8 to 48 hours in Observation?
Your physician will determine if you need to be admitted as an inpatient, or are well enough to go home.

Observation status has been shown to improve patient care. At Northern Westchester Hospital, the staff is careful to instruct the patient and family of the patient’s status, and to constantly reevaluate the need for continued observation.