title: Observation encounters and subsequent nursing facility stays.
abstract: BACKGROUND
  Medicare coverage of skilled nursing facility (SNF) care requires that beneficiaries have a 3-night inpatient stay in the prior 30 days to be eligible. Time spent by beneficiaries receiving hospital-based observation services does not count toward this requirement.
  
  
  OBJECTIVE
  To examine the frequency of Medicare beneficiary discharge from hospital-based observation services to SNFs and its impact on Medicare coverage.
  
  
  METHODS
  Retrospective cohort study.
  
  
  RESULTS
  In 2010, 195,068 community-dwelling beneficiaries received hospital-based observation services. Beneficiaries were overwhelmingly (96.5%) discharged back to the community without home health services. Only 1.2% (2319) were discharged to non-covered SNFs, while 0.6% (1196) were discharged to covered SNFs. Patients discharged to SNFs experienced longer lengths of stay (LOS) than those discharged back to the community (34.9 hours vs 25.5 hours; P<.01). Approximately one-fourth of beneficiaries discharged to SNFs had an observation LOS of 48 hours or more.
  
  
  CONCLUSIONS
  While only a small minority of community-dwelling Medicare beneficiaries who received hospital-based observation services in 2010 were discharged to an SNF not covered by Medicare, the implications for these patients and the associated costs deserve attention. These findings have important implications for Medicare's observation service and 2-midnight policies.
authors.affiliation: 16 Laguna St, Apt 303, San Francisco, CA 94102. E-mail: anitavashi@gmail.com.
authors.forename: Anita A
authors.initials: AA
authors.lastname: Vashi
authors.forename: Susannah G
authors.initials: SG
authors.lastname: Cafardi
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Powers
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States