For the past several years, health care reform efforts have focused on reducing preventable hospital readmissions. However, a new study co-authored by Brad Wright, assistant professor of health management and policy at the University of Iowa, suggests that when the rising number of patients hospitalized for outpatient observation is factored in, declines in readmissions disappear.
According to the study, “Commercial payers and state Medicaid agencies have increasingly [required] hospitals to report data on readmissions and…occasionally [link] reimbursement and purchasing agreements to performance. Consequently, although experts continue to challenge the usefulness of readmission rates for assessing quality of care, the rates are now broadly accepted as a measure of hospital quality by payers and policymakers.”
Wright and lead author Amber K. Sabbatini, assistant professor of emergency medicine at the University of Washington, studied data for the period between 2007 and 2015 from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database. They examined claims for emergency department visits that resulted in observation stays and followed these patients to measure 30-day readmission trends. These data were used to compare observation stay readmission trends to inpatient stay readmission trends.
Sabbatini and Wright found that while inpatient readmissions decreased from 17.8% to 15.5% during the study period, 30-day readmissions after an outpatient observation stay increased from 10.9% to 14.8%. The data also showed that repeat observation stays increased from 3.6% to 6.9%.
While some may be tempted to see these results as evidence of hospitals using observation stays to game readmissions measures and avoid the penalties associated with them, Sabbatini and Wright stress that this is not the case. Rather, the study concludes that observation stays should be considered part of 30-day readmission quality measurements in order to ensure that hospitals focus the same amount of resources on preventing readmissions in these patients.
“All patients with an acute condition require timely and coordinated care,” the authors wrote. “Moreover, there is no reason to think that a repeat observation stay is any less preventable or less reflective of the quality of care transitions than an inpatient readmission. Although repeat observation stays cost payers less than inpatient readmissions, they still represent excess costs for the health care system and are meaningful for patients.”