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Observation Rates At Veterans' Hospitals More Than Doubled During 2005-13, Similar To Medicare Trends.

Published on Oct 1, 2015in Health Affairs5.711
· DOI :10.1377/hlthaff.2014.1474
Brad Wright9
Estimated H-index: 9
(UI: University of Iowa),
Amy M. J. O’Shea4
Estimated H-index: 4
(Roy J. and Lucille A. Carver College of Medicine)
+ 3 AuthorsMary Vaughan Sarrazin22
Estimated H-index: 22
(Roy J. and Lucille A. Carver College of Medicine)
Abstract
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 2005–13, we identified trends and variations in observation rates across twenty-one Veteran Integrated Service Networks and 128 VHA hospitals nationwide. We found that observation rates across VHA hospitals more than doubled, from 6.5 percent to 13.8 percent, and that there was substantial variation across both Veteran Integrated Service Networks and hospitals. The most prevalent diagnoses accounted for an increasing share of observation stays over time. Despite different incentives within the VHA and Medicare, rates...
  • References (15)
  • Citations (13)
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References15
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#1Ann M. Sheehy (UW: University of Wisconsin-Madison)H-Index: 13
#2Ben K. Graf (UW: University of Wisconsin-Madison)H-Index: 21
Last. Elizabeth A. Jacobs (UW: University of Wisconsin-Madison)H-Index: 32
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#1Robert M. Wachter (UCSF: University of California, San Francisco)H-Index: 58
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Protocolized observation care in dedicated hospital units can result in higher-value care for some conditions, but by treating observation billing for inpatient care the same as for observation-unit care, current policy promotes cost shifting without rewarding higher value.
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Under Medicare's Hospital Readmissions Reduction Program, two thirds of U.S. hospitals will receive penalties of up to 1% of Medicare reimbursements. But the program could exacerbate disparities in care and create disincentives to providing care for the very ill.
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#1Christopher W. Baugh (Brigham and Women's Hospital)H-Index: 11
#2Arjun K. Venkatesh (Robert Wood Johnson Foundation)H-Index: 18
Last. J. Stephen Bohan (Brigham and Women's Hospital)H-Index: 18
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Using observation units in hospitals to provide care to certain patients can be more efficient than admitting them to the hospital and can result in shorter lengths-of-stay and lower costs. However, such units are present in only about one-third of US hospitals. We estimated national cost savings that would result from increasing the prevalence and use of observation units for patients whose stay there would be shorter than twenty-four hours. Using a systematic literature review, national survey...
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#1Michael A. RossH-Index: 8
#2Taruna AuroraH-Index: 1
Last. Carol L. ClarkH-Index: 8
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Hospitals and emergency departments face the challenges of escalating healthcare costs, mismatched resource utilization, concern over avoidable admissions, and hospital and emergency department overcrowding. One approach that has been used by hospitals to address these issues is the use of emergency
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#1Zhanlian Feng (Brown University)H-Index: 31
#2Brad Wright (Brown University)H-Index: 9
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#1Arjun K. Venkatesh (Brigham and Women's Hospital)H-Index: 18
#2Benjamin P. Geisler (Harvard University)H-Index: 13
Last. Jeremiah D. Schuur (Harvard University)H-Index: 30
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Background Observation care is a core component of emergency care delivery, yet, the prevalence of emergency department (ED) observation units (OUs) and use of observation care after ED visits is unknown. Our objective was to describe the 1) prevalence of OUs in United States (US) hospitals, 2) clinical conditions most frequently evaluated with observation, and 3) patient and hospital characteristics associated with use of observation. Methods Retrospective analysis of the proportion of hospital...
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#2Arjun K. VenkateshH-Index: 18
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Importance Since the introduction of the rehospitalization rate as a quality measure, multiple changes have taken place in the US health care delivery system. Interpreting rehospitalization rates without taking a global view of these changes and new data elements from comprehensive electronic medical records yields a limited assessment of the quality of care. Objective To examine hospitalization outcomes from a broad perspective, including the implications of numerator and denominator definition...
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#2Claire Noel-Miller (Public Policy Institute of California)H-Index: 4
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Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs...
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#1Jennifer N. Goldstein (Christiana Care Health System)H-Index: 3
#2J. Sanford Schwartz (UPenn: University of Pennsylvania)H-Index: 61
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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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#1Gelareh Z. GabayanH-Index: 11
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Background: With the recent increase use of observation care, it is important to understand the characteristics of patients that utilize this care and either have a prolonged observation care stay or require admission. Methods: We a conducted a retrospective cohort study utilizing 5% sample data from Medicare patients age ≥65 years that was nationally representative in the year 2013. We performed a generalized estimating equation (GEE) logistic regression analysis to evaluate the relationship be...
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#1Brad Wright (UI: University of Iowa)H-Index: 9
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Study objective This study seeks to understand how emergency physicians decide to use observation services, and how placing a patient under observation influences physicians' subsequent decisionmaking. Methods We conducted detailed semistructured interviews with 24 emergency physicians, including 10 from a hospital in the US Midwest, and 14 from 2 hospitals in central and northern England. Data were extracted from the interview transcripts with open coding and analyzed with axial coding. Results...
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Abstract Objective To examine trends in the use of ED observation stays among a national sample of patients with commercial insurance, and assess the patient cost-burden of an observation stay relative to an short inpatient hospitalization from the ED. Methods Retrospective analysis of ED observation stays and inpatient hospitalizations from 2008 to 2015 using the Truven MarketScan® Commercial Claims and Encounters database. Index ED visits were identified from claims files and assessed for evid...
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#1Emily R. Adrion (Edin.: University of Edinburgh)H-Index: 3
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Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes. Despite the potential for changed policies to indirectl...
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