The appropriateness of observation has been a hot topic for the past several years as we have experienced rapid, continuous growth in observation status. In fact, according to MedPAC data, observation stays increased 96% from 2006 to 2013. We are also seeing an increase in long stay observation cases, with 26% of observation cases lasting at least two nights, and 11% lasting three in 2012.
The increase in observation use is due to providers' response to multiple factors, such as short inpatient stay scrutiny, ambiguity in appropriateness of inpatient admission, and fear of readmission penalties. But members often tell us they do not have a way to compare their observation performance to their peers'.
I'm here to tell you there's a tool at your fingertips that can do just that. Our Hospital Benchmark Generator includes Medicare benchmarks for financial, operational, and quality data. The tool allows you to select a cohort of hospitals that most closely resembles your organization and compare performance side-by-side. Your organization's data will be displayed in a red column.
How many patients do we assign observation status?
Once in the tool, look under the Operations Folder on the left side of the screen to find Observation Use. The third metric is Proportion of Hospital Stays with Observation, which includes all hospital stays (inpatient admissions and observation stays) that included time under outpatient observation status.
While this high-level data is useful for understanding overall performance, more granular data can help determine targets for performance improvement. By clicking View Details at the bottom of the tool users can view data by diagnosis, for example diseases of the heart.
In this example, the median proportion of hospital stays with observation for all cases was 18.4%, compared with 32.3% for diseases of the heart, signaling that this may be a good target for further analysis.
How many observation patients do we admit?
To compare the proportion observation patients that were eventually admitted as inpatient, view Observation Conversation Rate. Again, click View Details to see more granular data.
This analysis reveals that while 23% of all patients under observation are later admitted, 34% of cerebrovascular disease patients are admitted. This data suggests that focusing on developing admission standards specifically cerebrovascular disease patients may lower overall conversion rate.
How long are our patients typically under observation?
Finally, our tool offers average observation length of stay under Patient Average Hours Under Observation. This data will help identify any cases particularly susceptible to long observation stays at your organization.
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