Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

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]