While Hospital Admissions Decline, Observation Stays and Emergency Department Visits on the Rise

Trends showing fewer hospital admissions and more treat-and-release observation stays or emergency department (ED) visits have occurred among patients across all insurance categories, according to a recent AHRQ-funded study. “The Shifting Landscape in Utilization of Inpatient, Observation, and Emergency Department Services Across Payers,” published in the Journal of Hospital Medicine, showed hospital admissions decreased while observation and ED visits increased from 2009 to 2013 among patients who were uninsured or covered by Medicare, Medicaid or private insurance. Among Medicare patients, for example, admissions fell by 17 percent while observation stays increased by 33 percent. The study analyzed data from AHRQ's Healthcare Cost and Utilization Project for 10 common conditions in four states. Access the abstract.

2017 Jun;12(6):443-446. doi: 10.12788/jhm.2751.

The Shifting Landscape in Utilization of Inpatient, Observation, and Emergency DepartmentServices Across Payers.

Nuckols TK1, Fingar KR2, Barrett M3, Steiner CA4, Stocks C5, Owens PL5.

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Abstract

Recent policies by public and private payers have increased incentives to reduce hospital admissions. Using data from four states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, this study compared the payer-specific population-based rates of adults using inpatient, observation, and emergency department (ED) services for 10 common medical conditions in 2009 and in 2013. Patients had an expected primary payer of private insurance, Medicare, Medicaid, or no insurance. Across all four payer populations, inpatient admissions declined, and care shifted toward treat-and-release observation stays and ED visits. The percentage of hospitalizations that began with an observation stay increased. Implications for quality of care and costs to patients warrant further examination. Journal of Hospital Medicine 2017;12:443-446.