The recent drop in hospital readmissions among Medicare patients has been encouraging. Coinciding with this drop in readmissions, has been increased use of "observation status” or "observing patients" (or treating returning patients in the emergency department) rather than “readmitting” them.
Personally I have witnessed the growth in observation status on the medical wards, often struggling to figure out what to do for patients who would be best off staying in the hospital but do not meet criteria for "inpatient status" and therefore are at risk of uncovered costly charges for hospital days. It is not uncommon to have a handful of patients "admitted" to the medical ward under "observation" status, which is covered as a outpatient service. Hospitals now have clinicians that review records of all "admitted" patients and police "obs" vs "inpatient" status. This did not exist when I first began my medical training.
The attached Health Affairs blog raises an important unanswered question: Is Observation Status and Increased ED Care Responsible for the Decline in Readmissions?
As an example, the author, David Himmelstein, argues that for patients discharged after heart attacks, "the urgent return rate has actually risen slightly; the reported 1.8 percent fall in readmission is more than offset by a 0.7 percent increase in observation stays and a 1.2 percent increase in ED visits." The data to do more formal analyses is just now becoming available to researchers.
What has been your experience with obs status?
Is it plausible that at least at some hospitals the drop in readmissions is do to reclassification than actually quality improvement?
What are the implications for policy?
Link leads to: http://healthaffairs.org/blog/2015/08/27/quality-improvement-become-good-at-cheating-and-you-never-need-to-become-good-at-anything-else/