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“Implications of cost-sharing for observation care among Medicare beneficiaries: a pilot survey”

Published on Dec 1, 2019in BMC Health Services Research1.932
· DOI :10.1186/s12913-019-3982-8
Jennifer N. Goldstein3
Estimated H-index: 3
(Christiana Care Health System),
J. Sanford Schwartz61
Estimated H-index: 61
(UPenn: University of Pennsylvania)
+ 1 AuthorsLeRoi S. Hicks4
Estimated H-index: 4
(Christiana Care Health System)
Abstract
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 beneficiaries hospitalized under observation status care was surveyed. Out of 144 respondents, low-income beneficiaries were more likely to be concerned about the cost of their observation stay than higher-income respondents (70.7% vs29.3%, p = 0.015). If hospitalized under observation status again, there was a trend among low-income beneficiaries to request completion of their workup outside of the hospital (56.3% vs 43.8%), and to consider leaving against medical advice (AMA) (100% vs 0%), though these trends were not statistically significant (p = 0.30). The results of this pilot study suggest that low-income Medicare beneficiaries hospitalized under observation status have greater concerns about their cost-sharing obligations than their higher income peers. Cost-sharing for observation care may have unintended consequences on utilization for low-income beneficiaries. Future studies should examine this potential relationship on a larger scale.
  • References (14)
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References14
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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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BACKGROUND As observation care grows, Medicare beneficiaries are increasingly likely to revisit observation care instead of being readmitted. This trend has potential financial implications for Medicare beneficiaries because observation care—although typically hospital based—is classified as an outpatient service. Beneficiaries who are readmitted pay the inpatient deductible only once per benefit period. In contrast, beneficiaries who have multiple care episodes under observations status are sub...
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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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BACKGROUND In response to growing concern over frequency and duration of observation encounters, the Centers for Medicare and Medicaid Services enacted a rules change on October 1, 2013, classifying most hospital encounters of <2 midnights as observation, and those ≥2 midnights as inpatient. However, limited data exist to predict the impact of the new rule. OBJECTIVE To answer the following: (1) Will the rule reduce observation encounter frequency? (2) Are short-stay (<2 midnights) inpatient enc...
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Importance The Centers for Medicare & Medicaid Services (CMS) defines observation status for hospitalized patients as a “well-defined set of specific, clinically appropriate services,” usually lasting less than 24 hours, and that in “only rare and exceptional cases” should last more than 48 hours. Although an increasing proportion of observation care occurs on hospital wards, studies of patients with observation status have focused on the efficiency of dedicated units. Objective To describe inpa...
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