observation status

^[1]^[2]^[3]

Indications

meant to be a short period of time to assess whether a patient requires hospital admission
meant to last < 24 hours, rarely > 48 hours
Medicare considers observation an outpatient service paid under Medicare part B

duration of observation status stays has increased significantly, magnifying inherent problems with the policy
does not count towards the 3-day inpatient stay requirement for Medicare skilled nursing facility coverage

2 midnight rule states that any patient that spends 2 midnights in a hospital is considered an inpatient
- full implementation of the policy has been delayed until March 31, 2015
observation care increased significantly & hospitalization decreased significantly 2009-2013^[2]

↑ Sheehy AM, Graf B, Gangireddy S, et al. Hospitalized but not admitted. JAMA Intern Med. 2013;173(21):1991-1998. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23835927
Wachter RM. Observation status for hospitalized patients: a maddening policy begging for revision. JAMA Intern Med. 2013;173(21):1999-2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23835681
↑ ^2.0 ^2.1 Nuckols TK, Fingar KR, Barrett M et al. The shifting landscape in utilization of inpatient, observation, and emergency department services across payers. J Hosp Med 2017 Jun; 12:443. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28574534
Sabbatini AK, Hsia RY. It's time for a strategic approach to observation care. J Hosp Med 2017 Jun; 12:479. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28574543
↑ Observation Status Society of Hospital Medicine http://www.hospitalmedicine.org/Web/Advocacy/Key_Issues/Observation_Status/Web/Advocacy/Observation_Status.aspx?hkey=4b746745-7a0b-4295-a842-375bc28fe64a&gclid=CNOJ_ai08MECFUiRfgodkjUAEw