Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients

Keith D. Lind, Claire M. Noel-Miller, Lindsey R. Sangaralingham, Nilay D Shah, Erik P. Hess, Pamela Morin, Fernanda Bellolio

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.

Original languageEnglish (US)
JournalMedical Care Research and Review
DOIs
StateAccepted/In press - Jul 1 2017

Fingerprint

Medicare Part C
Observation
Inpatients
Government Programs
Pressure
Veterans
Medicare
Delivery of Health Care

Keywords

  • age-based disposition
  • divergent trends
  • medicare advantage
  • observation status
  • readmission substitute

ASJC Scopus subject areas

  • Health Policy

Cite this

Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients. / Lind, Keith D.; Noel-Miller, Claire M.; Sangaralingham, Lindsey R.; Shah, Nilay D; Hess, Erik P.; Morin, Pamela; Bellolio, Fernanda.

In: Medical Care Research and Review, 01.07.2017.

Research output: Contribution to journalArticle

@article{53f19cbd11834e21bc3c99d82490cc61,
title = "Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients",
abstract = "Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.",
keywords = "age-based disposition, divergent trends, medicare advantage, observation status, readmission substitute",
author = "Lind, {Keith D.} and Noel-Miller, {Claire M.} and Sangaralingham, {Lindsey R.} and Shah, {Nilay D} and Hess, {Erik P.} and Pamela Morin and Fernanda Bellolio",
year = "2017",
month = "7",
day = "1",
doi = "10.1177/1077558717718026",
language = "English (US)",
journal = "Medical Care Research and Review",
issn = "1077-5587",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients

AU - Lind, Keith D.

AU - Noel-Miller, Claire M.

AU - Sangaralingham, Lindsey R.

AU - Shah, Nilay D

AU - Hess, Erik P.

AU - Morin, Pamela

AU - Bellolio, Fernanda

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.

AB - Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.

KW - age-based disposition

KW - divergent trends

KW - medicare advantage

KW - observation status

KW - readmission substitute

UR - http://www.scopus.com/inward/record.url?scp=85042212680&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042212680&partnerID=8YFLogxK

U2 - 10.1177/1077558717718026

DO - 10.1177/1077558717718026

M3 - Article

C2 - 29148348

AN - SCOPUS:85042212680

JO - Medical Care Research and Review

JF - Medical Care Research and Review

SN - 1077-5587

ER -