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Background: Readmissions contribute to excessive care costs and burden for people living with dementia. Assessments of racial disparities in readmissions among dementia populations are lacking, and the role of social and geographic risk factors such as individual‐level exposure to greater neighborhood disadvantage is poorly understood. We examined the association between race and 30‐day readmissions in a nationally representative sample of Black and non‐Hispanic White individuals with dementia diagnoses. Methods: This retrospective cohort study used 100% Medicare fee‐for‐service claims from all 2014 hospitalizations nationwide among Medicare enrollees with dementia diagnosis linked to patient, stay, and hospital factors. The sample consisted of 1,523,142 hospital stays among 945,481 beneficiaries. The relationship between all cause 30‐day readmissions and the explanatory variable of self‐reported race (Black, non‐Hispanic White) was examined via generalized estimating equations approach adjusting for patient, stay, and hospital‐level characteristics to model 30‐day readmission odds. Results: Black Medicare beneficiaries had 37% higher readmission odds compared to White beneficiaries (unadjusted OR 1.37, CI 1.35–1.39). This heightened readmission risk persisted after adjusting for geographic factors (OR 1.33, CI 1.31–1.34), social factors (OR 1.25, CI 1.23–1.27), hospital characteristics (OR 1.24, CI 1.23–1.26), stay‐level factors (OR 1.22, CI 1.21–1.24), demographics (OR 1.21, CI 1.19–1.23), and comorbidities (OR 1.16, CI 1.14–1.17), suggesting racially‐patterned disparities in care account for a portion of observed differences. Associations varied by individual‐level exposure to neighborhood disadvantage such that the protective effect of living in a less disadvantaged neighborhood was associated with reduced readmissions for White but not Black beneficiaries. Conversely, among White beneficiaries, exposure to the most disadvantaged neighborhoods associated with greater readmission rates compared to White beneficiaries residing in less disadvantaged contexts. Conclusions: There are significant racial and geographic disparities in 30‐day readmission rates among Medicare beneficiaries with dementia diagnoses. Findings suggest distinct mechanisms underlying observed disparities differentially influence various subpopulations. [ABSTRACT FROM AUTHOR]

THE HRRP AND OBSERVATION HOSPITALIZATIONS The omission of observation hospitalizations from the HRRP "rehospitalization" metric is perhaps the most obvious shortcoming that has emerged.[[6], [8]] Although counterintuitive, hospitalization is not synonymous with inpatient admission. Eliminating observation stays as a separate hospital visit status entirely - meaning all hospital stays would simply be considered hospital inpatient admissions - would be a significant improvement, but this degree of policy shift would have far-reaching implications and is unlikely to happen. According to the MedPAC, from 2006 to 2016, outpatient services increased by 49.0% while inpatient discharges decreased by 21.8%.[15] Although observation is only one type of outpatient service, observation hospital care is nonetheless a significant portion of hospital outpatient services. Both studies included only index inpatient stays, followed by observation I or i inpatient stays within 30 days of the index inpatient stay. [Extracted from the article]

BACKGROUND/OBJECTIVES Observation stays are increasingly common for older adults, yet little is known about the extent to which they are being used as the Centers for Medicare and Medicaid Services (CMS) originally intended for unscheduled or acute problems and whether different types of services are reflected in current billing practices. DESIGN Observational cohort study. SETTING/PARTICIPANTS A total of 867,165 qualifying observation stays identified from 451,408 patients using Medicare fee‐for‐service claims data from a nationally representative 20% beneficiary sample between January 1, 2014, and November 30, 2014. MEASUREMENTS Using descriptive and multivariable logistic model analytic approaches, we evaluated the patient, stay, and hospital characteristics associated with the most common billing practice for observation stays (charge revenue center 0761 exclusively) vs all other practices. RESULTS: Sixty‐three percent of observation stays were billed exclusively under the 0761 revenue center and were more likely to be for preplanned chronic conditions consisting of short‐term treatments (eg, chemotherapy, radiation therapy, wound care, paracentesis, epidural spinal injection). These stays appeared to be used for recurrent single‐day visits, given their strong association with prior visits and a high rate of reobservation (41.4%), with frequent return stays appearing in a 7‐day pattern. CONCLUSION: Nearly two‐thirds of observation stays are billed using only the 0761 revenue code and appear to be for prescheduled, repeated treatments—differing substantially from CMSʼ explicitly stated purpose as a form of care used while a healthcare provider determines whether a patient presenting for unscheduled or acute conditions requires inpatient hospital admission or can be safely discharged. Guidance is needed from CMS to clarify the appropriate role of observation stays, with discussion as to whether episodic single‐day, planned treatment for chronic conditions not originating in the emergency department should be billed as observation stays or placed under another mechanism. Subsequent research is needed to understand how the current use of observation stays impact patient out‐of‐pocket costs. J Am Geriatr Soc 68:1568‐1572, 2020. [ABSTRACT FROM AUTHOR]