Hospital readmissions are an ongoing issue in many communities. In attempt to correct this issue, the Hospital Readmissions Reduction Program, which is part of the Affordable Care Act (2010), applies financial penalties to hospitals that have higher-than-expected readmission rates for specific conditions. It is a concern, however, that reductions in readmissions are being achieved by keeping the returning patients in observation units for a longer period of time instead of formally readmitting them. The purpose of this study was to examine changes in readmission rates and stays in observation units over time. This study also assessed whether hospitals that had greater increases in observation-service use had greater reduction in readmissions.
During this study, hospital-level rates of readmission and observation-service use within 30 days after discharge were compared monthly among Medicare beneficiaries. This study took place between October 2007 and May 2015 and 3387 hospitals were analyzed. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%. Also, rates for non targeted conditions declined from 15.3% to 13.1%. Furthermore, stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015. Overall, there was no significant association between changes in observation-unit stays and readmissions after implementation of the ACA in 2010.
Readmission trends seem to be consistent with hospitals’ responding to incentives to reduce readmissions. There was no conclusive evidence supporting that changes in observation-unit stays solely accounted for the decrease in readmissions.
Zuckerman, Rachael B., Sheingold, Steven H., Orav, John., et al. Readmissions, Observation, and the Hospital Readmissions Reduction Program. N Engl J Med. 2016.