News: Readmissions are down, but observation stays soar, study finds

A new study in the New England Journal of Medicine suggests that the reduction in hospital readmissions in recent years all but disappears when researchers factor in the increase in non-admitted patients being kept for observational stays, HealthLeaders Media reported.

The study’s findings may mean that there hasn’t been as much progress when it comes to lowering readmissions as proponents tout, study co-author Brad Wright, Ph.D, told HealthLeaders Media.

“[The study] is not just looking at people who were hospitalized who bounced back and now we are putting them all on observation. That takes away some of the reduction in readmissions, but not all of it,” said Wright. “It’s when you also include the observation stays as initial index events. That’s where the wipe out happens.”

The increase in observation cases isn’t necessarily a new thing, however. In 2012, a study in the Journal of Health Affairs, found that observation services increased 34% from 2007 to 2009. That study, however, did not measure the relation between readmissions and observation stays.

Of course, the increase in observation stays also opens up a potential new avenue for CDI programs, leading to many programs expanding to review these cases.

Not only can the prevalence of observation stays be negative for the financial health of the facility, but it can also be extremely taxing to the patients themselves, Wright points out.

“I saw recently that 10% of observation stays end up costing the patient more than an inpatient stay would, out of pocket. That never should happen,” he said. “It doesn’t seem right that patients who are technically outpatients should have to pay more than if they were an inpatient in the hospital.”

Editor’s note: To read HealthLeaders Media’s interview with Wright, click here. To read the study in the New England Journal of Medicine, click here. To listen to an episode of ACDIS Radio about expanding CDI reviews to observation cases, click here.