CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 1st, 2012

The Growing Number of Observation Stays: How Do You Decide?

The number of observation stays are growing in this country, in part as a response to Medicare audits that are disallowing admissions for some patients – and maybe in part to reduce crowding in the Emergency Medicine Department. The problem is that criteria are not clear, so there is likely a lot of variability across institutions. Also, there may be financial consequences for patients who incur a greater expense than if they were officially admitted.

In many places there is no difference between a short admission and an observation stay. It is also challenging to defend the decisions because clear guidance from Medicare about who needs an admission (or who should have an observation stay) are not available (as far as I know). Here are two recent articles on this issue, from The Wall Street Journal and The Boston Globe.

What is your experience? How are you deciding who should have an observation stay?

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One Response to “The Growing Number of Observation Stays: How Do You Decide?”

  1. William L Blanchet, MD says:
    March 2, 2012 at 9:16 pm

    The definitions of what qualifies for “observation” vs what qualifies for “admission to inpatient status” are totally arbitrary and have no meaningful relationship with what is or is not appropriate for the patient’s needs. This represents a foolish waste of resources so that Medicare can avoid paying some claims without overtly reducing reimbursement.

    This distinction is especially painful for the patient who needs skilled nursing rehab who does not “qualify” for inpatient status however the admission to skilled nursing rehab mandates an inpatient stay.

    There is no explaining insanity. This is insane.