In our continuation of focusing on health disparities, tracking metrics are paramount to our understanding if our interventions are to be impactful. Monitoring and categorizing hospitalizations are a crucial indicator. One can postulate that if hospitalizations drop within a defined population type and responses have been put in place to drive down such admissions, then such models have a direct effect on the outcome.
Unfortunately, this logic does not always hold and, therefore, requires further examination. A recent article in “Health Affairs” by Figueroa delineates such a discrepancy by thoroughly evaluating admission data. What they discovered in their research is that even though racial gaps in hospitalizations had decreased, it seems to be accompanied by an increase in observation stays in the same cohort.
This finding leads to a possible conclusion that the benefit seen is merely the result of status placement versus an actual decrease. Sure, one might argue that such a change means the intervention has a positive impact since an observation stay implies one is not as sick as an inpatient stay. However, the shift might also be the result of the growing focus on placing patients in the correct category, and thus, the admission status was initially incorrect.
Understanding these types of situations is extremely important for numerous reasons. First, as we innovate and implement ambulatory changes, we must have a method to know if they are having the desired outcomes. If we do not track and understand such metrics, we may not accomplish our stated goals.
Additionally, there is a financial impact on the patient in this situation, as mentioned earlier. For Medicare beneficiaries, observation status requires the patient to pay a percentage of the stay, categorized as an outpatient event, where as an inpatient stay is covered entirely. This designation becomes increasingly important when addressing racial disparities. There is an inherent risk of misinterpreting the intervention, thereby unintentionally causing worsening inequity. A category of an observation stay vs. inpatient hospitalization stay causes increasing a fiscal burden on an already monetarily challenged population.
This latter concern is more of a payment reform issue since observation status is associated with less acuity and a lower cost of care. Let us dissect and utilize this information to understand better how we, as scientists, must better comprehend the data and support payment reform that negatively impacts health disparities. Delivering high-quality care and protecting those we are blessed to serve from nonclinical health determinants is the goal of our profession. Only by standing up for reform that negatively affects the most vulnerable will we amend the underlying social inequalities and inequities that exist.