Observation Status for Hospitalized Patients: A Maddening Policy Begging for Revision

Published on Nov 25, 2013in JAMA Internal Medicine20.768
· DOI :10.1001/jamainternmed.2013.7306
Robert M. Wachter58
Estimated H-index: 58
(UCSF: University of California, San Francisco)
  • References (2)
  • Citations (9)
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Medicare beneficiaries hospitalized under observation status have significant cost-sharing responsibilities under Medicare Part B. Prior work has demonstrated an association between increased cost-sharing and health care rationing among low-income Medicare beneficiaries. The objective of this study was to explore the potential impact of observation cost-sharing on future medical decision making of Medicare beneficiaries. Single-center pilot cohort study. A convenience sample of Medicare benefici...
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More than 6 million Americans have heart failure (HF), and the prevalence continues to increase.[1][1] In 2010, there were ≈1 million hospitalizations for acute decompensated HF, with most in patients aged ≥65 years.[2][2] Accordingly, the healthcare costs associated with HF hospitalizations
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Abstract Background Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation c...
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Observation units are dedicated units built to provide efficient protocol-based care to patients with well-defined diagnoses or presenting symptoms such as chest pain, asthma, and congestive heart failure. Only approximately one-third of US hospitals currently have an observation unit. The efficiency which results from use of such units may improve bed capacity in individual hospitals and also provide great national cost savings as care is delivered safely in less time with use of fewer resource...
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