Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays

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 serv...

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Main Authors: WRIGHT, Brad, ZHANG, Xuan, RAHMAN, Momotazur, KOCHER, Keith
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Language:English
Published: Institutional Knowledge at Singapore Management University 2018
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Online Access:https://ink.library.smu.edu.sg/soe_research/2326
https://ink.library.smu.edu.sg/context/soe_research/article/3325/viewcontent/AEM_2018.pdf
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spelling sg-smu-ink.soe_research-33252020-01-02T06:53:21Z Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays WRIGHT, Brad ZHANG, Xuan RAHMAN, Momotazur KOCHER, Keith 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 2018-01-01T08:00:00Z text application/pdf https://ink.library.smu.edu.sg/soe_research/2326 info:doi/10.1016/j.annemergmed.2018.02.005 https://ink.library.smu.edu.sg/context/soe_research/article/3325/viewcontent/AEM_2018.pdf http://creativecommons.org/licenses/by-nc-nd/4.0/ Research Collection School Of Economics eng Institutional Knowledge at Singapore Management University Health Economics
institution Singapore Management University
building SMU Libraries
continent Asia
country Singapore
Singapore
content_provider SMU Libraries
collection InK@SMU
language English
topic Health Economics
spellingShingle Health Economics
WRIGHT, Brad
ZHANG, Xuan
RAHMAN, Momotazur
KOCHER, Keith
Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays
description 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
format text
author WRIGHT, Brad
ZHANG, Xuan
RAHMAN, Momotazur
KOCHER, Keith
author_facet WRIGHT, Brad
ZHANG, Xuan
RAHMAN, Momotazur
KOCHER, Keith
author_sort WRIGHT, Brad
title Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays
title_short Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays
title_full Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays
title_fullStr Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays
title_full_unstemmed Informing medicare's Two-Midnight Rule policy with an analysis of hospital-based long observation stays
title_sort informing medicare's two-midnight rule policy with an analysis of hospital-based long observation stays
publisher Institutional Knowledge at Singapore Management University
publishDate 2018
url https://ink.library.smu.edu.sg/soe_research/2326
https://ink.library.smu.edu.sg/context/soe_research/article/3325/viewcontent/AEM_2018.pdf
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