Funding: This work was funded by the Retirement Research Foundation (Grant No. 2011–066), the National Institute on Aging (Grant No. P01AG027296) and the Agency for Healthcare Research and Quality (Grant No. 5T32H000011–27). The Medicare enrollment and claims data used in this analysis were made available through a data use agreement (DUA 21845) authorized by the Centers for Medicare and Medicaid Services.
Trends in Observation Care Among Medicare Fee-for-Service Beneficiaries at Critical Access Hospitals, 2007-2009
Article first published online: 22 FEB 2013
© 2013 National Rural Health Association
The Journal of Rural Health
Volume 29, Issue s1, pages s1–s6, August 2013
How to Cite
Wright, B., Jung, H.-Y., Feng, Z. and Mor, V. (2013), Trends in Observation Care Among Medicare Fee-for-Service Beneficiaries at Critical Access Hospitals, 2007-2009. The Journal of Rural Health, 29: s1–s6. doi: 10.1111/jrh.12007
Disclosures: None of the authors have any disclosures to report.
- Issue published online: 14 AUG 2013
- Article first published online: 22 FEB 2013
- Retirement Research Foundation. Grant Number: 2011–066
- National Institute on Aging. Grant Number: P01AG027296
- Agency for Healthcare Research and Quality. Grant Number: 5T32H000011–27
- critical access hospital;
- observation care;
Observation care is used to evaluate patients prior to admission or discharge. Often beneficial, such care also imposes greater financial liability on Medicare beneficiaries. While the use of observation care has increased recently, critical access hospitals (CAHs) face different policies than prospective payment (PPS) hospitals, which may influence their observation care use.
We used 100% Medicare inpatient and outpatient claims files and enrollment data for years 2007 to 2009, and the 2007 American Hospital Association data to compare trends in the likelihood, prevalence and duration of observation stays between CAHs and PPS hospitals in metro and non-metro areas among fee-for-service Medicare beneficiaries over age 65.
While PPS hospitals are more likely to provide any observation care, the 3-year increase in the proportion of CAHs providing any observation care is approximately 5 times as great as the increase among PPS hospitals. Among hospitals providing any observation care in 2007, the prevalence at CAHs was 35.7% higher than at non-metro PPS hospitals and 72.8% higher than at metro PPS hospitals. By 2009, these respective figures had increased to 63.1% and 111%. Average stay duration increased more slowly for CAHs than for PPS hospitals.
These data suggest that a growing proportion of CAHs are providing observation care and that CAHs provide relatively more observation care than PPS hospitals, but they have shorter average stays. This may have important financial implications for Medicare beneficiaries.