Health Services Research & Development

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Silver BC, Rahman M, Wright B, Besdine R, Gozalo P, Mor V. Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions. Health services research. 2018 Dec 1; 53(6):4747-4766.
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Abstract: OBJECTIVE: To examine the effects of Medicare's Medical Review (MR) program on short-stay inpatient hospitalization. DATA SOURCES/STUDY SETTING: One Hundred percent of Medicare Part A and Part B claims and the Master Beneficiary Summary File (2007-2010). STUDY DESIGN: Retrospective observational study using a difference-in-differences approach. We examined six primary intake diagnoses, we believed likely to be targeted by MR. We stratified by hospital profit structure, bed size, system membership, and inpatient admission rate to test for differential effects. The comparison group was hospital visits occurring in those MACs that had yet to implement, as well as those that did not implement during the period of interest. DATA COLLECTION: None. PRINCIPAL FINDINGS: Medical Review significantly reduced the likelihood of inpatient admission for patients with an intake diagnosis of "Non-Specific Chest Pain" by 1.29 percentage points (p < .001). This effect was stronger in larger hospitals (-2.03, p < .001), nonsystem hospitals (-2.54, p < .001), and those with a lower inpatient rate (-1.86, p < .001). CONCLUSIONS: Short inpatient hospitalizations were emphasized by MR, and our results show that MR modestly reduced their prevalence among certain patients and certain hospitals. Future work should examine whether this resulted in adverse patient outcomes.