ArticleHealth services research2023
Medicare's hospital readmissions reduction program and the rise in observation stays.
Article in Health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Predicting 30-day readmission using DRG-based hospitalization data: a large real-world logistic regression model from a tertiary hospital.Frontiers in public health · 2026Article
- Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias.Journal of the American Geriatrics Society · 2024Article
- Medicare's hospital readmissions reduction program and the rise in observation stays.Health services research · 2023Article
- Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.Health services research · 2023Article
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use. DATA SOURCES AND STUDY
settingA nationally representative sample of fee-for-service Medicare claims, January 2009-September 2016. STUDY
designUsing a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies. DATA COLLECTION/EXTRACTION
methodsWe derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N = 7,162,189). PRINCIPAL
findingsObservation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01% points per month [95% CI -0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02% points per month [95% CI 0.002, 0.04]). Results for the COPD analysis were statistically insignificant in both policy periods.
conclusionsThe increase in observation stays is likely due to other factors, including audit activity and clinical advances.
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