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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)
Abstract
  • References (2)
  • Citations (9)
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References2
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#1Edward A. Ross (UF: University of Florida)H-Index: 25
#2Frank B. Bellamy (UF: University of Florida)H-Index: 3
With increasingly strict guidelines for insurance coverage, hospitals have adopted meticulous resource utilization review and management processes. It is important for physicians to appreciate that careful documentation of certain patient parameters may not only optimize the facility's reimbursement but have profound impact on the patient's out-of-pocket expenses. Hospital utilization teams have access to the frequently changing national payor guidelines for policy benefits, usually revolving ar...
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#1Robert M. Wachter (UCSF: University of California, San Francisco)H-Index: 58
#2Scott A. FlandersH-Index: 10
Last. Peter J. Pronovost (Johns Hopkins University)H-Index: 103
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The administration of antibiotics within 4 hours to patients with community-acquired pneumonia has been criticized as a quality standard because it pressures clinicians to rapidly administer antibiotics despite diagnostic uncertainty at the time of patients' initial presentations. The measure was recently revised (to 6 hours) in response to this criticism. On the basis of the experience with the 4-hour rule, the authors make 5 recommendations for the development of future publicly reported quali...
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#1Jennifer N. Goldstein (Christiana Care Health System)H-Index: 3
#2J. Sanford Schwartz (UPenn: University of Pennsylvania)H-Index: 61
Last. LeRoi S. Hicks (Christiana Care Health System)H-Index: 4
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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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#1Umair Khalid (BCM: Baylor College of Medicine)H-Index: 4
#2Anita Deswal (BCM: Baylor College of Medicine)H-Index: 43
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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#1Jennifer N. Goldstein (Christiana Care Health System)H-Index: 3
#2Zugui Zhang (Christiana Care Health System)H-Index: 1
Last. LeRoi S. Hicks (Christiana Care Health System)H-Index: 4
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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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#1Graham P. Martin (University of Leicester)H-Index: 30
#2Brad Wright (UI: University of Iowa)H-Index: 9
Last. Damian Roland (University Hospitals of Leicester NHS Trust)H-Index: 12
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Study objective Accumulating evidence has shown increasing use of observation stays for patients presenting to emergency departments and requiring diagnostic evaluation or time-limited treatment plans, but critics suggest that this expansion arises from hospitals' concerns to maximize revenue and shifts costs to patients. Perspectives of physicians making decisions to admit, observe, or discharge have been absent from the debate. We examine the views of emergency physicians in the United States ...
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#1Brad WrightH-Index: 9
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Last. Mary Vaughan-SarrazinH-Index: 26
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AbstractRecent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals.The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system c
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#1Brad Wright (UI: University of Iowa)H-Index: 9
#2Amy M. J. O’Shea (Roy J. and Lucille A. Carver College of Medicine)H-Index: 4
Last. Mary Vaughan Sarrazin (Roy J. and Lucille A. Carver College of Medicine)H-Index: 22
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When neither inpatient admission nor prompt discharge is clearly indicated for a patient in the emergency department, physicians place the patient under observation in a hospital for diagnosis and treatment. The increasing prevalence of observation stays at hospitals reimbursed by Medicare is receiving considerable attention, but the prevalence remains unexplored in Veterans Health Administration (VHA) hospitals, which are subject to different payment policies. Using VHA data for fiscal years 20...
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#1Charles F S Locke (Johns Hopkins University)H-Index: 4
#2Ann M. Sheehy (UW: University of Wisconsin-Madison)H-Index: 13
Last. Brent G. Petty (Johns Hopkins University)H-Index: 16
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Outpatient versus inpatient status determinations for hospitalized patients impact how hospitals bill Medicare for hospital services. Medicare policies related to status determinations and the Recovery Audit Contractor (RAC) program charged with postpayment review of such determinations are of increasing concern to hospitals and physicians. We present an overview and discussion of these policies, including the recent 2-midnight rule, the effect on status determinations by the RAC program, and ot...
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#1Jason Napolitano (UCLA: University of California, Los Angeles)H-Index: 2
#2Inderpreet Saini (UCLA: University of California, Los Angeles)H-Index: 1
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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