Hospitals may treat patients in EDs, observation stays to avoid readmissions penalties: study

Patients revisiting the hospital within 30 days of initial discharge increasingly receive care in emergency departments and observation stays, marking a shift that may reflect hospitals' efforts to avoid CMS penalties for readmissions, according to a study published Aug. 12 in the BMJ.

Researchers studied hospital stays among Medicare patients using Medicare Provider Analysis and Review files from Jan. 1, 2012, to Oct. 1, 2015. Each patient had a discharge diagnosis of one of three conditions for which hospitals face CMS fines: heart failure, acute myocardial infarction and pneumonia. 

Among patients who revisited the hospital, the researchers distinguished between those who were readmitted to the hospital, for which hospitals can receive CMS fines, and those treated in emergency departments or as observation stays, which are not fined by CMS.

They found the number of readmissions declined throughout the study period, an outcome often associated with improved care quality. However, the number of post-discharge observation stays and emergency department visits increased over the same period, resulting in an overall increase in hospital revisits. 

The decline in readmissions may be due to hospitals' efforts to avoid CMS penalties by treating returning patients in emergency departments and as observation stays, the study's authors wrote. They suggested measuring all revisits within 30 days of discharge, not just readmissions, could provide a better metric for evaluating hospitals' performance.

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