Clinician-performed ultrasonography during the Boston marathon bombing mass casualty incident.

acute inpatient status for patients who required a stay of less than 48 hours. But now there is a growing population of patients labeled as facility observation status by payers who still require the resources generally provided by a hospital inpatient unit. These “complex” observation status patients place the hospitals and physicians in an untenable position. Unfortunately, observation has morphed to the point that it is being used by Interqual and Medicare more as a billing status rather than a clinical process. According to selective use of the literature, entire groups of patients have been artificially classified as no longer meeting acute inpatient admission criteria. Regrettably, this prescribed criterion limits the physician’s ability to decide on an appropriate level of care. The campaign waged against 1-day acute inpatient admissions is the cause of this shift. Thus, through a complex cascade of regulations and abdication, CMS has actually blurred the definition of observation, created fear of denials, fines, or loss of accreditation for admitting patients, and through the onerous copayment requirements restricted the ability of seniors to gain access to short-term rehabilitation.