Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions

Benjamin C Silver; Momotazur Rahman; Brad Wright; Richard Besdine; Pedro Gozalo; Vincent Mor

doi:10.1111/1475-6773.13036

Back

Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions

Journal article

Open access

Peer reviewed

Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions

Benjamin C Silver, Momotazur Rahman, Brad Wright, Richard Besdine, Pedro Gozalo and Vincent Mor

Health services research, Vol.53(6), pp.4747-4766

12/2018

DOI: 10.1111/1475-6773.13036

PMCID: PMC6232404

PMID: 30182432

Files and links (1)

url

https://europepmc.org/articles/pmc6232404View

Published (Version of record) Open Access

Abstract

To examine the effects of Medicare's Medical Review (MR) program on short-stay inpatient hospitalization. One Hundred percent of Medicare Part A and Part B claims and the Master Beneficiary Summary File (2007-2010). Retrospective observational study using a difference-in-differences approach. We examined six primary intake diagnoses, we believed likely to be targeted by MR. We stratified by hospital profit structure, bed size, system membership, and inpatient admission rate to test for differential effects. The comparison group was hospital visits occurring in those MACs that had yet to implement, as well as those that did not implement during the period of interest. None. Medical Review significantly reduced the likelihood of inpatient admission for patients with an intake diagnosis of "Non-Specific Chest Pain" by 1.29 percentage points (p < .001). This effect was stronger in larger hospitals (-2.03, p < .001), nonsystem hospitals (-2.54, p < .001), and those with a lower inpatient rate (-1.86, p < .001). Short inpatient hospitalizations were emphasized by MR, and our results show that MR modestly reduced their prevalence among certain patients and certain hospitals. Future work should examine whether this resulted in adverse patient outcomes.

Aged

Aged, 80 and over

Fee-for-Service Plans

Female

Hospitalization

Humans

Insurance Claim Review - statistics & numerical data

Length of Stay

Male

Medicare - statistics & numerical data

Patient Admission - statistics & numerical data

Retrospective Studies

United States

Details

Title: Subtitle: Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions
Creators: Benjamin C Silver - Brown University
Momotazur Rahman - Brown University
Brad Wright - University of Iowa
Richard Besdine - Brown University
Pedro Gozalo - Brown University
Vincent Mor - Brown University
Resource Type: Journal article
Publication Details: Health services research, Vol.53(6), pp.4747-4766
DOI: 10.1111/1475-6773.13036
PMID: 30182432
PMCID: PMC6232404
NLM abbreviation: Health Serv Res
ISSN: 0017-9124
eISSN: 1475-6773
Grant note: R21 AG047102 / NIA NIH HHS P01 AG027296 / NIA NIH HHS
Language: English
Date published: 12/2018
Academic Unit: Public Policy Center (Archive)
Record Identifier: 9984364534802771

Metrics

14 Record Views

4 Times Cited - Web of Science

See more details