“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)
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.
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