title: Factors associated with prolonged observation services stays and the impact of long stays on patient cost.
abstract: BACKGROUND
  Patients are treated using observation services (OS) when their care needs exceed standard outpatient care (i.e., clinic or emergency department) but do not qualify for admission. Medicare and other private payers seek to limit this care setting to 48 hours.
  
  
  METHODS
  Healthcare Cost and Utilization Project data from 10 states and data collected from two additional states for 2009.
  
  
  METHODS
  Bivariate analyses and hierarchical linear modeling were used to examine patient- and hospital-level predictors of OS stays exceeding 48 (and 72) hours (prolonged OS). Hierarchical models were used to examine the additional cost associated with longer OS stays.
  
  
  RESULTS
  Of the 696,732 patient OS stays, 8.8 percent were for visits exceeding 48 hours. Having Medicaid or no insurance, a condition associated with no OS treatment protocol, and being discharged to skilled nursing were associated with having a prolonged OS stay. Among Medicare patients, the mean charge for OS stays was $10,373. OS visits of 48-72 hours were associated with a 42 percent increase in costs; visits exceeding 72 hours were associated with a 61 percent increase in costs.
  
  
  CONCLUSIONS
  Patient cost sharing for most OS stays of less than 24 hours is lower than the Medicare inpatient deductible. However, prolonged OS stays potentially increase this cost sharing.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA; Center for Comprehensive Access Delivery Research and Evaluation, Iowa City Veterans Health Care System, Atlanta, GA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
authors.forename: Ryan
authors.initials: R
authors.lastname: Mutter
authors.forename: Marguerite
authors.initials: M
authors.lastname: Barrett
authors.forename: Judy
authors.initials: J
authors.lastname: Parlato
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ross
mesh_terms: D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States; D057832:Watchful Waiting / Q000191:economics* / Q000706:statistics & numerical data*
keywords: Medicare payment policy; Observation services; observation unit; patient cost