Under pressure from Medicare, hospitals hold more seniors for observation
This map shows how monthly incidence of "observation stays" per 1,000 Medicare beneficiaries varies across states -- lower in the West, higher in the South and Midwest. Credit: Feng Group/Brown University
Nobody wins when patients stay in the hospital unnecessarily, so the federal government in recent years has pushed hospitals to be careful about admitting Medicare recipients as inpatients. The apparent result is that more patients are being "held for observation" instead, according to a new study by Brown University gerontologists. While the shift in how hospitals care for elderly patients in the emergency department may reduce costs to Medicare, it can also increase out-of-pocket expenditures for patients.
"The dual trends of increasing hospital observation services and declining inpatient admissions suggest that hospitals and physicians may be substituting observation services for inpatient admissions perhaps to avoid unfavorable Medicare audits targeting hospital admissions," the researchers wrote in their study published in the June edition of the journal Health Affairs.
In the study, the researchers found that although the rate of observation stays varies widely by state and even by hospital, the nationwide ratio of Medicare patients who are "held for observation" to those who are admitted for inpatient stays increased 34 percent between 2007 and 2009.
Being held for observation, especially for days, can appear to patients to be exactly the same experience as being admitted until they get the bill. That's because people held for observation are classified as outpatients. Under Medicare rules, outpatients may face higher co-pays for their in-hospital services and won't be covered for subsequent care in skilled nursing facilities. Zhanlian Feng, assistant professor of health services, policy, and practice and first author on the paper, said he first thought to conduct the study when he read media reports of patients who were surprised by their higher costs after spending nights in the hospital.
"They never thought they were being treated as outpatients," Feng said.
More observation for longer
The practice has alarmed patient advocacy groups, one of which launched a class-action suit against the government last year. The groups had claimed the practice was increasing. Feng, a gerontology researcher in Brown's Program in Public Health, figured he could contribute to the debate by determining whether that was true.
"I had not seen the numbers," he said. "That really prompted me to do some real research."
The results show that to a specific and significant degree, the increase is not just a perception. After reviewing Medicare records of 29 million fee-for-service Medicare beneficiaries 65 and older in 2007, 2008, and 2009, Feng and his two co-authors found several trends:
- Observation stays rose to 1,019,881 (involving 2.9 per 1,000 beneficiaries) in 2009 from 814,692 (2.3 per 1,000 beneficiaries) in 2007;
- Inpatient admissions fell to 22.5 per 1,000 beneficiaries in 2009 from 23.9 per 1,000 in 2007;
- Observation stays got an average of 7 percent longer over the study period;
- In 2009, 44,843 patients were held for observation longer than 72 hours, compared to 23,841 in 2007;
- By state, observation stay rates in 2009 varied from a low of 0.8 per 1,000 beneficiaries in New York to 5.9 per 1,000 in West Virginia.
In its efforts to contain Medicare costs by preventing unnecessary hospitalization, the government has pulled several new levers in the last decade. In 2006 officials signaled an increase in audits of inpatient admissions, and in 2004 they allowed hospitals to change a patient's status retroactively from inpatient to outpatient with observation before discharge. Most recently, the Affordable Care Act of 2010 includes a provision penalizing hospitals if they have high readmission rates. Classifying patients as outpatients, either on their first or second visit, helps hospitals steer clear of counting them as readmitted.
Feng said he hopes the research will help policymakers better understand the facts surrounding the controversial issue. One area for further investigation, he said, could be to determine the clinical circumstances that led tens of thousands of patients to be held for observation for longer than three days. Another could be to determine how many patients held for observation actually faced any financial consequences for holding the outpatient versus inpatient designation.
Journal reference: Health Affairs
Provided by Brown University
- Tenet, Community Health fight gets nasty Apr 11, 2011 | not rated yet | 0
- Shorter hospital stay for knee replacement linked with greater revision, mortality risks Feb 09, 2012 | not rated yet | 0
- Doctors' decisions on initial hospital admissions may affect readmission rates May 13, 2011 | not rated yet | 0
- Better scheduling of admissions can reduce crowding at children's hospitals May 24, 2011 | not rated yet | 0
- Medicare Part D associated with reduction in nondrug medical spending Jul 26, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Calorie information in fast food restaurants used by 40 percent of 9-18 year olds when making food choices
A new study published online today (Thursday) in the Journal of Public Health has found that of young people who visited fast food or chain restaurants in the U.S. in 2010, girls and youth who were obese were more likely ...
Health 9 hours ago | not rated yet | 0
(HealthDay)—Implementation of systematic monitoring for medication adherence will allow for identification of barriers to adherence and tailoring of interventions, according to a viewpoint piece published ...
Health 11 hours ago | not rated yet | 0
(AP)—The Obama administration says more doctors and hospitals are embracing technology as adoption of computerized medical records reaches a "tipping point" in America.
Health 12 hours ago | not rated yet | 0
Johns Hopkins researchers report that hospitals may be reaping enormous income for patients whose hospital stays are complicated by preventable bloodstream infections contracted in their intensive care units.
Health 13 hours ago | not rated yet | 0
A University of Illinois researcher says that the cornerstone of our efforts to alleviate food insecurity should be to encourage more people to participate in the Supplemental Nutrition Assistance Program (SNAP) "because ...
Health 13 hours ago | not rated yet | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
16 hours ago | 4.9 / 5 (7) | 0 |
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
16 hours ago | 4.7 / 5 (3) | 0 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
13 hours ago | 5 / 5 (2) | 2 |
Existing research shows that bicyclists who wear helmets have an 88 percent lower risk of brain injury, but researchers at Boston Children's Hospital found that simply having bicycle helmet laws in place showed a 20 percent ...
5 hours ago | not rated yet | 0
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
12 hours ago | 4 / 5 (2) | 0 |
A new approach for immunizing against influenza elicited a more potent immune response and broader protection than the currently licensed seasonal influenza vaccines when tested in mice and ferrets. The vaccine ...
13 hours ago | not rated yet | 0 |