Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings

Emergency department utilization among adults with epilepsy: A multi-state cross-sectional analysis, 2010-2019

OBJECTIVE

We described patterns and trends in ED use among adults with epilepsy in the United States.

METHODS

Utilizing inpatient and ED discharge data from seven states, we conducted a cross-sectional analysis to identify adult ED visits diagnosed with epilepsy or seizures from 2010 to 2019. Using ED visit counts and estimates of state-level epilepsy prevalence, we calculated ED visit rates overall and by payer, condition, and year.

RESULTS

Our data captured 304,935 ED visits with epilepsy as a primary or secondary diagnosis in 2019. Across the seven states, visit rates ranged between 366 and 726 per 1000 and were higher than rates for adults without epilepsy in all states but one. ED visit rates were highest among Medicare and Medicaid beneficiaries (vs commercial or self-pay). Adults with epilepsy were more likely to be admitted as inpatients. Visits for nervous system disorders were 6.3-8.2 times higher among people with epilepsy, and visits for mental health conditions were 1.2-2.6 times higher. Increases in ED visit rates from 2010 to 2019 among people with epilepsy exceeded increases among adults without by 6.0-27.3 percentage points.

CONCLUSION

Adults with epilepsy visit the ED frequently and visit rates have been increasing over time. These results underscore the importance of identifying factors contributing to ED use and designing tailored interventions to improve ambulatory care quality.

Hospital ownership and admission rates from the emergency department, evidence from Florida

OBJECTIVE

In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department.

DATA SOURCES

We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019.

STUDY DESIGN

We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument.

DATA COLLECTION/EXTRACTION METHODS

Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults.

PRINCIPAL FINDINGS

Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009.

CONCLUSION

Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels.

Same-Day Outpatient Lower-Extremity Joint Replacement: A Critical Analysis Review

➢ The economics of transitioning total joint arthroplasty (TJA) to standalone ambulatory surgery centers (ASCs) should not be capitalized on at the expense of patient safety in the absence of established superior patient outcomes. ➢ Proper patient selection is essential to maximizing safety and avoiding complications resulting in readmission. ➢ Ambulatory TJA programs should focus on reducing complications frequently associated with delays in discharge. ➢ The transition from hospital-based TJA to ASC-based TJA has substantial financial implications for the hospital, payer, patient, and surgeon.

Medicare Two-Midnight Rule Accelerated Shift To Observation Stays

During the past two decades several policies have attempted to replace inappropriate hospital inpatient stays with observation hospital stays, where patients receive hospital care but are classified as outpatients. The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used. For hospitals, the administrative burden associated with making these status determinations is substantial. We found that after the Two-Midnight rule was implemented, potentially inappropriate short inpatient stays decreased immediately by 2.0 stays per 1,000 beneficiaries and potentially more appropriate short outpatient stays increased immediately by 1.8 stays per 1,000 beneficiaries, hastening a preexisting trend in this direction. However, after this initial improvement, the rate of change slowed to a new steady state. Given the steady state and ongoing administrative resources needed, it is time to reconsider the value of status determination required by the Two-Midnight rule.