Journal article
Medicare's Hospital Readmissions Reduction Program and the Rise in Observation Stays
Health services research, Vol.58(3), pp.554-559
06/2023
DOI: 10.1111/1475-6773.14142
PMCID: PMC10154161
PMID: 36755372
Abstract
To evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use.
A nationally representative sample of fee-for-service Medicare claims, January 2009 - September 2016.
Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies.
We derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N=7,162,189).
Observation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01 percentage points per month [95% CI -0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02 percentage points per month [95% CI 0.002, 0.04]). Results for the COPD analysis were statistically insignificant in both policy periods.
The increase in observation stays is likely due to other factors, including audit activity and clinical advances.
Details
- Title: Subtitle
- Medicare's Hospital Readmissions Reduction Program and the Rise in Observation Stays
- Creators
- Brad Wright - University of South CarolinaCanada Parrish - University of Washington School of MedicineAnirban Basu - University of WashingtonKaren E Joynt Maddox - Washington University in St. LouisJoshua M Liao - University of WashingtonAmber K Sabbatini - University of Washington
- Resource Type
- Journal article
- Publication Details
- Health services research, Vol.58(3), pp.554-559
- DOI
- 10.1111/1475-6773.14142
- PMID
- 36755372
- PMCID
- PMC10154161
- NLM abbreviation
- Health Serv Res
- eISSN
- 1475-6773
- Grant note
- DOI: 10.13039/100000049, name: National Institute on Aging, award: R01AG063759
- Language
- English
- Electronic publication date
- 02/08/2023
- Date published
- 06/2023
- Academic Unit
- Public Policy Center (Archive)
- Record Identifier
- 9984366298902771
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