MEDICARE OBSERVATION STATUS: IMPLICATIONS FOR MICHIGAN MEDICINE GERIATRIC PATIENTS

Abstract

Background: Centers for Medicare and Medicaid Services (CMS) define "Observation Status" for patients with specific services requiring length of stays lasting no longer than 48 hours. Evidence shows, however, that "Observation Status " stays can often last longer than 48 hours and therefore are associated with high out-of-pocket costs for patients and pose barriers to discharge (Sheehy, 2013). Advocates for Observation Status highlight the cost savings for hospitals, while crit-ics cite the prohibitive out-of-pocket costs for patients (Adrion, 2017). Methods: In order to gain insight into how this policy impacts older adults, geriatric social workers with the Michigan Medicine Geriatric Inpatient Consultation Team used chart reviews to collect information from 50 geriatric patients who were categorized under "Observation Status" at least once during their hospitalization. Information such as admitting diagnosis, treatment recommendations, disposition, and outcomes following discharge was collected. Additional information such as LACE score, the use of a sitter or video monitor, and whether or not a dementia or delirium was diagnosed during the hospital stay was collected. Results: Of the 50 charts that were reviewed, we were surprised to learn that 22 of the 50 patients had a diagnosis of dementia or MCI. The most common visit diagnosis was for falls yet the average length of stay was 7.4 nights in contrast to the perception that observation patients should be discharged within 48 hours. Conclusions: University of Michigan's Institute for Healthcare Policy and Innovation recently published research citing the cost savings of Observation Status (Adrion, 2017). However, the information from our current project highlights unconsidered burdens for older adults including longer lengths of stay, especially for those with cognitive issues. As pointed out in several research articles, patients under Observation Status do not qualify for subacute rehabilitation under traditional Medicare policy and consequently are at a higher risk for readmission to the hospital (Mason, 2014). Our initial findings, based on longer than usual lengths of stay and high readmission rates for older adults with altered mental status and/or a dementia diagnosis indicate the need for further work in this area.