Publication Type

Journal Article

Version

acceptedVersion

Publication Date

1-2018

Abstract

Outpatient observation stays are increasingly substituting for standard inpatient hospitalizations. In 2013, the Centers for Medicare & Medicaid Services adopted the controversial Two-Midnight Rule policy to curb long observation stays and better define the use of hospital-based observation services versus inpatient hospitalizations. We seek to determine the extent to which Medicare beneficiaries exposed to long observation stays (>48 hours) are clinically similar to those with short observation stays (≤48 hours) because this has relevance to the Two-Midnight Rule.\nUsing 100% Medicare claims data from 2008 to 2010, we identified all patients with long observation stays (>48 hours) who were admitted through the emergency department (ED). We report beneficiary characteristics, as well as crude and risk-adjusted 30-day rates of mortality, readmissions, and return ED visits stratified by observation stay length.\nSeven percent of 2.8 million observation stays were greater than 48 hours. Beneficiaries with long observation stays tended to be older, women, nonwhite, and urban residents, with a greater number of comorbid conditions. Crude rates increased with observation stay length for all 3 outcomes. However, after directly standardizing the rates, we observed the reverse trend because all adjusted rates decreased stepwise with observation stay length greater than 48 hours in a dose-response pattern.\nPatients with observation stays lasting longer than 48 hours are a clinically distinct population. Our findings support the conceptual underpinnings of the Two-Midnight Rule, but suggest that observation versus inpatient determinations should be based on actual length of stay rather than prospective prediction to reduce the administrative ambiguity this policy has created.\nSTUDY OBJECTIVE\nMETHODS\nRESULTS\nCONCLUSION

Discipline

Health Economics

Research Areas

Applied Microeconomics

Publication

Annals of Emergency Medicine

Volume

72

Issue

2

First Page

166

Last Page

170

ISSN

0196-0644

Identifier

10.1016/j.annemergmed.2018.02.005

Publisher

Elsevier: 12 months

Additional URL

https://doi.org/10.1016/j.annemergmed.2018.02.005

Download

Share

COinS