The Latest: Do Observation Stays Account for the Drop in Preventable Readmissions?
Posted on March 08, 2016 |
In late 2015, the Wall Street Journal published an article identifying an increase in hospital observation stays coinciding with a reduction in readmissions. It was possible, the authors noted, that the celebrated decline in 30-day readmissions was due in large part to hospitals simply changing the labels they assigned to patients. Observation status allows hospitals to provide care for patients who fall in a gray area between self-sufficiency and the need for inpatient care; however, it is recognized as an outpatient service. Therefore, because a patient is not admitted to the facility, that stay is not considered an admission – or a readmission.
This finding was understandably disconcerting to a healthcare community acutely focused on reducing 30-day readmissions through a variety of refined care coordination and quality improvement initiatives. If the data and interpretations were accurate, the efforts of these stakeholders could be interpreted as ineffective in improving health outcomes for their patients.
A more granular analysis published recently in the New England Journal of Medicine (NEJM) clarifies these assertions. First, the study acknowledges that observation status totals gradually increased throughout the studied period from late 2007 to early 2015. Of note, however, is the fact that the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program (HRRP) was not implemented until FY 2013; therefore, this steady increase began three years before the advent of HRRP readmissions penalties. In addition, when the researchers looked at data within hospitals, they did not identify a relationship between the increase in observation status and the decrease in readmissions; that is, they did not find evidence that the two were related. Instead, these changes occurred simultaneously but without a significant relationship to one another.
While the NEJM researchers are unable to establish a causal relationship between readmissions reductions efforts and the decline in numbers, they did note two important findings. First, rates of decrease for all readmissions increased after the passage of the Affordable Care Act (ACA) in 2010. Interestingly, the rates of readmission decreased most substantially after that date for those conditions that were included in the first years of HRRP under the ACA: acute myocardial infarction, heart failure, and pneumonia, suggesting that these changes might be due at least in part to intentionally readmissions reductions efforts in these areas.*
*This analysis did not include readmissions for an index diagnosis for COPD given that CMS enacted penalties for excessive COPD index admissions after the time frame included in this analysis.
Read the Wall Street Journal's December 2015 analysis here and the NEJM article here.
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