Journal article
The Origin and Disposition of Medicare Observation Stays
Medical care, Vol.52(9), pp.796-800
09/01/2014
DOI: 10.1097/MLR.0000000000000179
PMCID: PMC4134386
PMID: 25054826
Abstract
Background: Growing use of hospital observation care continues unabated despite growing concerns from Medicare beneficiaries, patient advocacy groups, providers, and policy makers. Unlike inpatient stays, outpatient observation stays are subject to 20% coinsurance and do not count toward the 3-day stay required for Medicare coverage of skilled nursing facility (SNF) care. Despite the policy relevance, we know little about where patients originate or their discharge disposition following observation stays, making it difficult to understand the scope of unintended consequences for beneficiaries, particularly those needing postacute care in a SNF.
Objective: To determine Medicare beneficiaries' location immediately preceding and following an observation stay.
Research Design: We linked 100% Medicare Inpatient and Outpatient claims data with the Minimum Data Set for nursing home resident assessments. We then flagged observation stays and conducted a descriptive claims-based analysis of where beneficiaries were immediately before and after their observation stay.
Results: Most patients came from (92%) and were discharged to (90%) the community. Of >1 million total observation stays in 2009, just 7537 (0.75%) were at risk for high out-of-pocket expenses related to postobservation SNF care. Beneficiaries with longer observation stays were more likely to be discharged to SNF.
Conclusions: With few at risk for being denied Medicare SNF coverage due to observation care, high out-of-pocket costs resulting from Medicare outpatient coinsurance requirements for observation stays seem to be of greater concern than limitations on Medicare coverage of postacute care. However, future research should explore how observation stay policy might decrease appropriate SNF use.
Details
- Title: Subtitle
- The Origin and Disposition of Medicare Observation Stays
- Creators
- Zhanlian Feng - University of IowaHye-Young Jung - Weill Cornell MedicineBrad Wright - Brown UniversityVincent Mor - Brown University
- Resource Type
- Journal article
- Publication Details
- Medical care, Vol.52(9), pp.796-800
- DOI
- 10.1097/MLR.0000000000000179
- PMID
- 25054826
- PMCID
- PMC4134386
- NLM abbreviation
- Med Care
- ISSN
- 0025-7079
- eISSN
- 1537-1948
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 5
- Grant note
- 2011-066 / Retirement Research Foundation 5T32H000011-27 / Agency for Healthcare Research and Quality; United States Department of Health & Human Services; Agency for Healthcare Research & Quality P01AG027296 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Language
- English
- Date published
- 09/01/2014
- Academic Unit
- Public Policy Center (Archive)
- Record Identifier
- 9984364459002771
Metrics
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