Q: Does the Affordable Care Act require Medicare beneficiaries over age 75 to be admitted to the hospital by their primary care physician?
A: No. There is no such requirement in the law.
Can this possibly be true?
Perhaps you've heard this one about a change in Medicare affecting seniors over 75:
It's a claim attached to the "Judge Kithil" chain email that just won't die. But this claim — like many others in the chain email above — is wrong.
"I can say without hesitation this is false," said Andrea Callow, a policy attorney for the nonpartisan Center for Medicare Advocacy, in an email to FactCheck.org.
Callow wrote that "nothing in the Affordable Care Act contains a requirement that a primary care physician admit a patient if they are 76 or older." She said Medicare coverage for hospital care is based on the Social Security Act's criteria for Medicare Parts A and B, as well as rules and guidance from the Centers for Medicare & Medicaid Services.
"There is nothing about age or PCP vs. ED doctor in the law that affects a beneficiary's Medicare coverage," Callow wrote, referring to a primary care physician and emergency department doctor.
In addition, a spokesman for the Centers for Medicare & Medicaid Services told us that "we know of no such provision in the ACA that required this."
Indeed, the Medicare.gov website says that Medicare Part A covers hospital services when "a doctor makes an official order" saying you need inpatient hospital care for treatment. The website does not say that it has to be your "primary care physician," as the email says.
Furthermore, CMS issued guidance on "Hospital Inpatient Admission Order and Certification" on Jan. 30. It covers how to submit an order for inpatient services for someone, as well as who may submit the order, as a condition of payment under Medicare Part A. The guidance does not say that a primary care physician must make the order, either.
We're not sure how this particular claim came about, but it's not the first time we've heard of problems the Affordable Care Act supposedly creates for those over the age of 75.
In 2012, we wrote about a bogus claim that under the health care law "no one over 75 will be given major medical procedures unless approved by locally administered Ethics Panels."
And the same email claiming that primary care physicians must admit patients to hospitals in order for Medicare to cover costs also says that, because of the ACA, "at age 76 when you most need it most, you are not eligible for cancer treatment." That's also not true.
That inaccurate claim was based on a misreading of H.R. 3200, an old House health care bill from 2009 that did not become law. David Kithil, a former judge in Burnet County, Texas, made the claim that cancer hospitals "will ration care according to the patient's age" in a letter he had published in the River Cities Daily Tribune. He cited page 272 of the bill to support his claim about rationed cancer treatments.
But as we wrote in a lengthy analysis debunking several of the claims made in Kithil's letter and elsewhere, page 272 of the bill merely called for a study of whether a certain class of hospitals incur higher costs than some others for the cancer care they deliver. The bill actually would've allowed Medicare to pay those hospitals more for their higher costs. There was no mention of denying cancer treatments for those over 75 or otherwise.
Versions of Kithil's long since outdated letter have been forwarded widely for nearly five years now. Even he says it's "not accurate" and he wishes it would just "die."
Callow, of the Center for Medicare Advocacy, thinks the bogus claim about Medicare patients needing to be admitted by primary care physicians stems from a long-standing concern about how Medicare bills patients classified as "outpatients" even though they stay overnight for "observation services."
"Your hospital status (whether the hospital considers you an 'inpatient' or 'outpatient') affects how much you pay for hospital services (like X-rays, drugs, and lab tests) and may also affect whether Medicare will cover care you get in a skilled nursing facility," the Centers for Medicare & Medicaid Services warns in a pamphlet that urges Medicare patients to clarify their status within hours of arriving at the hospital.
Callow said the issue concerning observation care, which her organization has followed since at least 2000, also has nothing to do with the Affordable Care Act, or which physician is responsible for admitting the patient.
"If I had to wager a bet, I would say the original Judge Kithil email got jumbled with some information on observation status and this is what came out," she said.
Factcheck.org is a nonpartisan, nonprofit "consumer advocate" for voters that aims to reduce the level of deception and confusion in U.S. politics. Based in Philadelphia, Factcheck monitors the factual accuracy of what is said by major U.S. political players in the form of TV ads, debates, speeches, interviews and news releases. Its goal is to apply the best practices of both journalism and scholarship, and to increase public knowledge and understanding. Find a list of Factcheck.org funders here.
Callow, Andrea. Center for Medicare Advocacy. Email sent to FactCheck.org. 24 Mar 2014.
Centers for Medicare & Medicaid Services. Hospital Inpatient Admission Order and Certification. 30 Jan 2014.
Centers for Medicare & Medicaid Services. "Are You a Hospital Inpatient or Outpatient?" Feb 2011. Accessed 25 Mar 2014.
Tergesen, Anne. "Beware Medicare's 'Observation' Status." Wall Street Journal. 19 Oct 2013.
Jackson, Brooks, et al. "Twenty-six Lies About H.R. 3200." FactCheck.org. 28 Aug 2009.
Blackburn, Scott. " 'Death Panels' Redux." FactCheck.org. 20 Apr 2012.