Abstract:
BACKGROUND/OBJECTIVES:Observation stays are increasingly common for older adults, yet little is known about the extent to which they are being used as the Centers for Medicare and Medicaid Services (CMS) originally intended for unscheduled or acute problems and whether different types of services are reflected in current billing practices. DESIGN:Observational cohort study. SETTING/PARTICIPANTS:A total of 867,165 qualifying observation stays identified from 451,408 patients using Medicare fee-for-service claims data from a nationally representative 20% beneficiary sample between January 1, 2014, and November 30, 2014. MEASUREMENTS:Using descriptive and multivariable logistic model analytic approaches, we evaluated the patient, stay, and hospital characteristics associated with the most common billing practice for observation stays (charge revenue center 0761 exclusively) vs all other practices. RESULTS:Sixty-three percent of observation stays were billed exclusively under the 0761 revenue center and were more likely to be for preplanned chronic conditions consisting of short-term treatments (eg, chemotherapy, radiation therapy, wound care, paracentesis, epidural spinal injection). These stays appeared to be used for recurrent single-day visits, given their strong association with prior visits and a high rate of reobservation (41.4%), with frequent return stays appearing in a 7-day pattern. CONCLUSION:Nearly two-thirds of observation stays are billed using only the 0761 revenue code and appear to be for prescheduled, repeated treatments-differing substantially from CMS' explicitly stated purpose as a form of care used while a healthcare provider determines whether a patient presenting for unscheduled or acute conditions requires inpatient hospital admission or can be safely discharged. Guidance is needed from CMS to clarify the appropriate role of observation stays, with discussion as to whether episodic single-day, planned treatment for chronic conditions not originating in the emergency department should be billed as observation stays or placed under another mechanism. Subsequent research is needed to understand how the current use of observation stays impact patient out-of-pocket costs. J Am Geriatr Soc 68:1568-1572, 2020.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Powell WR,Kaiksow FA,Kind AJH,Sheehy AMdoi
10.1111/jgs.16441subject
Has Abstractpub_date
2020-07-01 00:00:00pages
1568-1572issue
7eissn
0002-8614issn
1532-5415journal_volume
68pub_type
杂志文章abstract::Although computerized physician order entry (CPOE) has been successfully implemented in many acute care hospitals, few descriptions of its use in the long-term care (LTC) setting are available. This report describes the experiences of one LTC facility in developing and implementing a CPOE system with clinical decision...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53515.x
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journal_title:Journal of the American Geriatrics Society
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更新日期:2008-12-01 00:00:00
abstract:OBJECTIVES:To compare the value of dual tasking in predicting falling in the general population of oldest old with that of easy-to-administer single tasks. DESIGN:Prospective population-based follow-up study. SETTING:Municipality of Leiden, the Netherlands. PARTICIPANTS:Representative cohort of 380 individuals, all ...
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15224
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1988.tb04371.x
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1997.tb05965.x
更新日期:1997-09-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb05442.x
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Mammographic screening for breast cancer is of uncertain clinical benefit for women 75 years of age and older. Some have argued against instituting routine screening in this age group, noting that disability and shorter life expectancy may diminish the desirability and cost-effectiveness of sc...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1998.tb02746.x
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVES:To determine whether genetic variants in the ciliary neurotrophic factor (CNTF) gene are associated with muscle strength in older women. DESIGN:Cross-sectional analysis of baseline data from the Women's Health and Aging Studies I (1992) and II (1994), complementary population-based studies. SETTING:Twelve ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2006.00693.x
更新日期:2006-05-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1980.tb00004.x
更新日期:1980-12-01 00:00:00
abstract:OBJECTIVES:To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization. DESIGN:Cross-sectional and longitudinal analysis using existing data sets of a national survey. SETTING:A national survey. PARTICIPANTS:The anal...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.03172.x
更新日期:2010-12-01 00:00:00
abstract::Cognitive function is often impaired in type I diabetes mellitus, especially when onset is in early childhood. Limited evidence suggests similar impairment in the much larger population of older persons with type II diabetes. We report here the results of 13 measures of mental efficiency in persons between 65 and 77 y...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1990.tb02398.x
更新日期:1990-05-01 00:00:00
abstract::The purpose of this study was to compare attitudes toward the use of long-term care between older Japanese Americans (n = 1,244) and older Caucasian Americans (n = 1,354). When presented with a hypothetical situation in which they have dementia, 39% of older Japanese Americans and 42% of older Caucasians intended to b...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50275.x
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16781
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doi:10.1111/jgs.13392
更新日期:2015-05-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1999.tb03001.x
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVES:To explore associations between serum 25-hydroxyvitamin D (25(OH)D) levels and a wide range of health conditions, physical performance measures, disability, and mortality in a large epidemiological study to identify an optimum range for 25(OH)D concentrations. DESIGN:Cross-sectional study, with additional p...
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doi:10.1111/jgs.12693
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1988.tb04024.x
更新日期:1988-06-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1988.tb03433.x
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doi:10.1111/j.1532-5415.1998.tb02468.x
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2003-06-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:2002-04-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,meta分析,评审
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更新日期:2012-12-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:2014-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1993-11-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
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更新日期:2015-09-01 00:00:00
abstract:OBJECTIVES:To review studies investigating cochlear implant (CI) outcomes in older adults, and to develop a conceptual framework demonstrating important interactions between characteristics of hearing disability, aging, and the CI intervention. DESIGN:Review of English literature with titles containing the words "coch...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.2012.04150.x
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVES:To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons. DESIGN:A community-based, prospective, observational study. SETTING:Participant data from the Cardiovascular Health Study. PARTICIPANTS:From the overall sample of 5,...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53202.x
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVES:To determine whether function-related indicators (FRIs), derived from preadmission claims data, help explain the frequent practice of forgoing secondary prevention medications observed in Medicare. DESIGN:Retrospective cohort. SETTING:National Medicare data. PARTICIPANTS:Elderly Medicare beneficiaries dis...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13953
更新日期:2016-03-01 00:00:00