Navigation Links
Under pressure from Medicare, hospitals hold more seniors for observation
Date:6/11/2012

PROVIDENCE, R.I. [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.

Federal pressure

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.


'/>"/>

Contact: David Orenstein
david_orenstein@brown.edu
401-863-1862
Brown University
Source:Eurekalert  

Related medicine news :

1. UT MD Anderson study finds cancer related pain often undertreated
2. Wilderness Medicine founder offers health tips for summer season
3. Rheumatic heart disease is significantly under-treated in Africa and India
4. Brain surgery for epilepsy underutilized
5. Shingles Vaccine Safe, Underutilized, Study Says
6. On-the-job deaths steady in Michigan; Number of burn injuries underreported
7. Seniors Undertreated for Asthma, and Many Skip Inhalers: Study
8. Researchers gain better understanding of mechanism behind tau spreading in the brain
9. Understanding and promoting mental health - Insights from psychological science
10. National initiative launched to change the way biology departments approach undergraduate education
11. Safer kidney cancer surgery under-used for poorer, sicker Medicare, Medicaid patients
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Under pressure from Medicare, hospitals hold more seniors for observation
(Date:6/26/2016)... ... June 26, 2016 , ... PawPaws brand pet supplements owned ... developed to enhance the health of felines. The formula is all-natural and is made ... in the PawPaws Cat Kidney Support Supplement Soft Chews are Astragalus Root ...
(Date:6/25/2016)... Austin, TX (PRWEB) , ... June 25, 2016 , ... ... Fellow of the American College of Mohs Surgery and to Dr. Russell Peckham for ... popular and highly effective treatment for skin cancer. The selective fellowship in Mohs Micrographic ...
(Date:6/25/2016)... , ... June 25, 2016 , ... As a lifelong ... Cum Laude and his M.D from the David Geffen School of Medicine at UCLA. ... to Los Angeles to complete his fellowship in hematology/oncology at the UCLA-Olive View-Cedars Sinai ...
(Date:6/24/2016)... ... June 24, 2016 , ... A recent article published June ... with. The article goes on to state that individuals are now more comfortable seeking ... common operations such as calf and cheek reduction. The Los Angeles area medical group, ...
(Date:6/24/2016)... ... June 24, 2016 , ... The Pulmonary ... Dallas that it will receive two significant new grants to support its work ... marked its 25th anniversary by recognizing patients, medical professionals and scientists for their ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016  American Respiratory Labs (ARL), a ... now able to perform sophisticated lung assessments in patients, homes, thanks ... Inc. Patients are no longer limited to having ... PRO ® , ARL patients like Jeanne R. of ... the comfort of her own home. ...
(Date:6/24/2016)... According to a new market ... Needles, Safety Pen Needles), Needle Length (4mm, 5mm, 6mm, ... of Purchase (Retail, Non-Retail) - Trends & Global Forecasts ... market for the forecast period of 2016 to 2021. ... by 2021 from USD 1.65 Billion in 2016, growing ...
(Date:6/24/2016)... Belgium , June 24, 2016 ... the appointment of Dr. Edward Futcher ... Non-Executive Director, effective June 23, 2016.Dr. Futcher was ... Nominations and Governance Committees.  As a non-executive member ... independent expertise and strategic counsel to VolitionRx in ...
Breaking Medicine Technology: