{"doi":"10.1111/1475-6773.14142","title":"Medicare's hospital readmissions reduction program and the rise in observation stays","abstract":"OBJECTIVE: To evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use. DATA SOURCES AND STUDY SETTING: A nationally representative sample of fee-for-service Medicare claims, January 2009-September 2016. STUDY DESIGN: Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies. DATA COLLECTION/EXTRACTION METHODS: We derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N = 7,162,189). PRINCIPAL FINDINGS: Observation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01% points per month [95% CI -0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02% points per month [95% CI 0.002, 0.04]). Results for the COPD analysis were statistically insignificant in both policy periods. CONCLUSIONS: The increase in observation stays is likely due to other factors, including audit activity and clinical advances.","journal":"Health Services Research","year":2023,"id":369813,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.549,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":528460,"name":"Canada Parrish","orcid":"0000-0002-8490-5370","position":1,"is_corresponding":false},{"id":249135,"name":"Anirban Basu","orcid":"0000-0003-4238-7402","position":2,"is_corresponding":false},{"id":314071,"name":"Karen E. Joynt Maddox","orcid":"0000-0003-3779-8653","position":3,"is_corresponding":false},{"id":719363,"name":"Joshua M. Liao","orcid":"0000-0002-9788-9074","position":4,"is_corresponding":false},{"id":709860,"name":"Amber K. Sabbatini","orcid":"0000-0002-0451-8355","position":5,"is_corresponding":false},{"id":950965,"name":"Brad Wright","orcid":"0000-0002-2674-4951","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T01:15:32.670954Z","pmid":"36755372","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}