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Observation Stays and Readmissions for Older Adults: Implications for Medicare Policies

老年人的观察停留和再入院：对医疗保险政策的影响

基本信息

批准号：
10614922
负责人：
Amber Kathleen Sabbatini
金额：
$ 41万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-15 至 2025-02-28
项目状态：
未结题

项目摘要

SUMMARY Each year, more than 3.4 million Medicare beneficiaries are hospitalized as outpatients under observation. These observation stays have comprised a rapidly increasing proportion of unscheduled hospitalizations among older adults in the US. Controversial Medicare policies, including the Recovery Audit Contractor (RAC) Program and the 2-Midnight Rule, have greatly incentivized hospitals to care for patients via observation instead of an inpatient admission. Additionally, the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher-than-expected rates of readmissions for certain conditions, may have also had the untoward consequence of incentivizing hospitals to use observation to avoid readmission penalties. Yet, despite their growing importance in hospital care and the complex policy environment driving their use, few studies have examined how observation stays impact patient’s quality of care and outcomes. Recent evidence shows that 30-day readmissions are increasing among patients with observation stays, despite concomitant declines among inpatients. These disparate trends are significant given that federal quality programs, such as the HRRP, have thus far entirely ignored observation stays in hospital-based care delivery. Similarly, hospitals are not held accountable for other outcomes for patients hospitalized under observation, such as mortality. As a result, there has been little incentive for hospitals to ensure high-quality and effective care for patients with observation stays relative to inpatients. In this context, this study aims to fill critical gaps in our understanding of the consequences the growth of observation stays on patient outcomes. Using longitudinal Medicare claims and quasi-experimental methods, we will specifically answer the following questions: 1) What is the contemporary national landscape of readmissions, post-discharge ED use, mortality, and acute care costs for patients with observation stays, and how does this compare to inpatients across hospitals?; 2) How have current Medicare payment reforms, including the Recover Audit Contractor (RAC) program, 2-Midnight Rule and HRRP, impacted the use of observation stays, and more importantly, have they had unintended consequences on patient outcomes?; 3) Finally, how should observation stays be accounted for in national quality programs to fully reflect the care needs of older adults requiring hospital care? This study will be the most comprehensive examination to date of outcomes for Medicare beneficiaries with observation stays, and is specifically designed to inform clinical and policy decision-making around observation care for older adults.

总结每年有340多万医疗保险受益人作为门诊病人住院接受观察。这些观察住院包括计划外住院的比例迅速增加在美国的老年人中。有争议的医疗保险政策，包括恢复审计承包商（RAC）计划和2-午夜规则，极大地激励了医院通过观察来照顾病人而不是住院此外，医院再入院减少计划（HRRP），对某些条件下再入院率高于预期的医院进行惩罚，激励医院使用观察来避免再次入院处罚的不良后果。然而，尽管它们在医院护理中的重要性越来越大，而且复杂的政策环境推动了它们的使用，很少有研究探讨观察期如何影响患者的护理质量和结果。最近有证据表明，30天的再入院率在观察住院的患者中正在增加，住院患者的并发症下降。考虑到联邦质量，诸如HRRP的项目迄今为止完全忽略了基于医院的护理提供中的观察停留。同样，医院也不对住院观察的病人的其他结果负责，例如死亡率。因此，医院几乎没有动力来确保高质量和有效相对于住院病人，观察期病人的护理。在这方面，本研究旨在填补关键空白在我们对后果的理解中，观察的增长停留在病人的结果上。使用纵向医疗保险索赔和准实验方法，我们将具体回答以下问题问题：1）当代国家的再入院率、出院后艾德使用率、死亡率、观察期患者的急性护理费用，以及与住院患者相比，医院？2)当前的医疗保险支付改革，包括恢复审计承包商（RAC）计划，2-午夜规则和HRRP，影响了观察停留的使用，更重要的是，他们是否是否对患者结局产生了非预期后果？3)最后，观察逗留应如何计算在国家质量计划中充分反映需要医院护理的老年人的护理需求？本研究这将是迄今为止对医疗保险受益人进行的最全面的检查，停留，并专门设计为通知临床和政策决策周围的观察护理，老年人

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Racial Inequities Across Rural Strata in Acute Stroke Care and In-Hospital Mortality: National Trends Over 6 Years.

DOI：
10.1161/strokeaha.121.035006
发表时间：
2022-05
期刊：
STROKE
影响因子：
8.3
作者：
Hammond, Gmerice;Waken, R. J.;Johnson, Daniel Y.;Towfighi, Amytis;Maddox, Karen E. Joynt
通讯作者：
Maddox, Karen E. Joynt

Medicare's hospital readmissions reduction program and the rise in observation stays.

DOI：
10.1111/1475-6773.14142
发表时间：
2023-06
期刊：
HEALTH SERVICES RESEARCH
影响因子：
3.4
作者：
Wright, Brad;Parrish, Canada;Basu, Anirban;Maddox, Karen Joynt E.;Liao, Joshua M.;Sabbatini, Amber K.
通讯作者：
Sabbatini, Amber K.

Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program.

DOI：
10.1001/jamanetworkopen.2022.42587
发表时间：
2022-11-01
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Sabbatini, Amber K.;Joynt-Maddox, Karen E.;Liao, Joshua M.;Basu, Anirban;Parrish, Canada;Kreuter, William;Wright, Brad
通讯作者：
Wright, Brad

Reducing Cardiovascular Maternal Mortality by Extending Medicaid for Postpartum Women.