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Observational stays for ambulatory care-sensitive conditions on the rise

Hospitalizations related to ambulatory care-sensitive conditions, or ACSCs — such as dehydration and UTIs — are typically avoidable when patients receive quality primary care. Although evidence suggests the rates of inpatient hospitalizations for ACSCs have decreased in recent years, the rates of hospitalizations “for observation,” which do not count as inpatient admissions, have increased, according to researchers.

The findings suggest that the quality of ambulatory care is not improving, they said.

“In recent years, there has been substantial focus on improving ambulatory care nationally,” Jose F. Figueroa, MD, MPH, an instructor of medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital, and colleagues wrote. “Therefore, rates of hospital admissions related to ACSCs are used with increasing frequency to assess and incentivize the performance in the ambulatory setting of health care professionals participating in national Medicare alternative payment programs, such as accountable care organizations and alternative quality contracts administered by private payers, which increase pressure on hospitals to admit fewer patients.”

Researchers analyzed data from a national sample of Medicare inpatients from 2011 to 2015 to identify hospitalizations for acute care conditions such as dehydration, bacterial pneumonia and UTIs, and chronic conditions such as short-term complications from diabetes, asthma in adults and heart failure.

In 2011, there were a total of 5,517 ACSC-related, potentially avoidable inpatient hospitalizations and 3,743 similarly avoidable observational stays per 100,000 Medicare beneficiaries, the researchers said. Although the number of hospitalizations decreased to 4,158 per 100,000 beneficiaries by 2015, the number observational stays increased to 4,718 per 100,000 beneficiaries.

During the study period, 75.2% of the decrease in avoidable inpatient hospitalizations were offset by the increase in observational stays, according to Figueroa and colleagues.

“Our study results suggest that the major part of the improvement in hospitalization rates for ACSCs is likely related to increased designation of patients for observational status,” the researchers wrote.

According to the authors, the findings question the progress made in ambulatory care in recent years and suggest that both potentially avoidable hospitalizations and observational stays should be used to assess primary care performance. – by Erin Michael

Disclosures: Figueroa reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.