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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 CMS' 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., (© 2020 The American Geriatrics Society.)

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]