Sherlock Holmes accused Dr Watson of seeing but not observing. Were Dr Watson a pediatric hospitalist, utilization reviewers would accuse him of observing but not hospitalizing or, more technically, of providing “observation-level care” rather than “inpatient-level care.” In this issue of Pediatrics, Fieldston et al1 convincingly demonstrate that there is no consistent difference between these 2 levels of care as applied to the pediatric population. Having excluded all potential rational explanations for these differences in billing status, the sole remaining conclusion (“no matter how improbable,” as Holmes would say) is that this is an arbitrary distinction used by payers to decrease reimbursement to both hospitals and physicians. Because pediatric hospital stays are frequently ≤2 days, hospitals caring for children, pediatricians, and families of hospitalized children are put at increased financial risk from this reduced reimbursement. Instead of spending our energy fighting each individual designation of observation-versus inpatient-level care,...
Dr Watson and the Case of Observation-Level Care
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
FINANCIAL DISCLOSURE: Dr Percelay has worked for McKesson Corporation as an independent contractor reviewing pediatric InterQual criteria for ∼8 of the last 10 years. Compensation has not exceeded $5000 per year.
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Jack Martin Percelay; Dr Watson and the Case of Observation-Level Care. Pediatrics June 2013; 131 (6): 1180–1181. 10.1542/peds.2013-0898
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