How can you demand "treatment" VS admitted for "observation" when dealing with ER / hospitals?

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Hospitals are using admitted for "observation" to beat the system regarding re-admissions penalties

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are hospitals in certain areas ER ranked
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And medications given during the observation are not covered by Medicare or by Part D, even medications that are part of the patients regular care.
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But the Medicare reimbursement if transferred to rehab is different.
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Hospitals are using the "observation unit" to help keep patients from returning back to the ER once released from the ER.

Last year I was in the observation unit for 2 days... I was glad I wasn't taking up a bed for a more critical patient.
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