“Our study suggests that health care systems are intensifying efforts to treat patients who come back to a hospital in ERs and as observation stays, potentially to make their readmission rates look lower,” he told Reuters Health in an email.

“It’s not clear whether greater use of ERs to treat patients, instead of an inpatient stay, has enhanced or worsened patients’ care quality and experience,” Dr. Wadhera noted. “In addition, observation stays can be associated with high out-of-pocket expenditures, and we need to better understand (whether) greater use of observation stays under the HRRP has increased financial strain on patients.”

Instead of imposing penalties through the HRRP, CMS “should work with hospitals that consistently struggle with high total hospital revisits and support tailored improvements in care delivery at these sites to help reduce unnecessary hospital revisits,” Dr. Wadhera said.
“I am not surprised at all by these results, which actually confirm what my colleagues and I found in an earlier study for NY state Medicare patients,” said Dr. Yue Li from University of Rochester School of Medicine and Dentistry, who wasn’t involved in the current study.
“The results somewhat reinforce the concern we had that hospitals may simply use ED and observation stay as a substitute for inpatient care to avoid CMS financial penalties, rather than improving the coordination of post-discharge care and addressing the real needs for better community support of recently discharged patients,” Dr. Li said in an email.

“The finding in this study that the increase in observation stays was faster for non-white patients is troubling given that before (and after) the HRRP, non-white patients tended to have a higher 30-day readmission rate,” Dr. Li noted. “Other vulnerable patients (Medicaid patients, those with multiple conditions or disabilities) may also be at a disadvantage under current and future Medicare policy changes.”