Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program¶
Sabbatini, A. K., Joynt-Maddox, K. E., Liao, J. M., Basu, A., Parrish, C., Kreuter, W., & Wright, B. (2022). Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program. JAMA Network Open, 5(11).
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- The same move applies one substrate over, in a hospital adopting a 30-day-readmission rate as a proxy for care quality: gaming (coding admissions as observation stays) erodes the bridge once the metric is made consequential
This sourceFully accounting for observation stays more than halved the apparent HRRP-era decrease in 30-day readmissions, and the program's association with lower readmissions disappeared — i.e., reclassifying inpatient admissions as observation stays (which are excluded from the readmission metric) once the metric became consequential hollowed out its validity as a proxy for care quality.
Supported in partVerified against the work's full text
Shows reclassification to observation stays accounts for over half the apparent HRRP-era readmission drop, but the authors expressly decline to say hospitals gamed the metric.
“More than half of the decrease in readmissions for target conditions appears to be attributable to the reclassification of inpatient admission to observation stays.”
- The same move applies one substrate over, in a hospital adopting a 30-day-readmission rate as a proxy for care quality: gaming (coding admissions as observation stays) erodes the bridge once the metric is made consequential
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