Alexandra Wilson Pecci | September 1, 2015
The Medicare rule requiring at least a three-day hospital stay before patients become eligible for coverage of skilled nursing care afterward “may be inappropriately lengthening” hospital stays, a researcher says.
Cost savings and less time in the hospital are the result when Medicare Advantage plans waive the decades-old rule requiring at least a three-day hospital stay before patients become eligible for coverage of skilled nursing care afterward, according to a new study by researchers at Brown University and published in Health Affairs.
The three-day rule for skilled nursing care eligibility was implemented back in the 1960s, when the average hospital stay was two-weeks long.
“Times have changed,” says Amal Trivedi, MD, MPH, associate professor at the Brown University School of Public Health, senior author of the study. Now the average length of stay in the hospital is about five days. So it would be reasonable to expect that it would also take less time for a care team to determine whether a patient should be discharged to a skilled nursing care facility.
“Every day in the hospital comes with some risk,” Trivedi says. Plus, “A day in the hospital is quite expensive.”
“If we could get patients out quicker it would be good for the patient, but also good for the Medicare program,” he says.
Medicare Advantage plans have more flexibility than traditional Medicare, and most of them have waived the three-day rule. Plans that waived the rule within the study period set up a natural experiment.
Comparing 14 plans that waived the rule during the study period with 14 that had the rule in place, allowed researchers to track changes over time.
They found that between 2006 and 2010 the average time in the hospital per year increased by half a day among 140,739 people in the plans that never waived the rule, but decreased by 0.2 days among 116,676 people in the otherwise similar plans after they waived the rule.
“The decline in length of stay was 0.7 days (or 10%) among hospitalized patients admitted to a skilled nursing facility,” Trivedi says. “Given the estimated costs of a hospital admission among a Medicare beneficiary, we estimate a savings of $1,500 for every admission concluding with a discharge to a SNF [skilled nursing facility].”
In addition to the estimated cost savings, less time in the hospital also means a smaller chance of patients developing hospital-acquired complications, such as blood clots or infections.
Waiving the rule not only resulted in a reduction in hospital days, but it also didn’t have “any evidence of adverse effects,” Trivedi says. For instance, it didn’t increase the probability of skilled nursing admissions, the number of skilled nursing admissions, or even the length-of-stay in a skilled nursing facility, the study said.
Neither did the researchers find increases in the average number of hospital admissions in the study population, which could have been a consequence if patients were discharged too early.
Wider implications of the study are harder to gauge.
“To what extent do these results generalize to the traditional Medicare program?” Trivedi asks. That’s a question for further study, the researchers conclude. Currently, the traditional Medicare program isn’t free to waive the three-day rule the way Medicare Advantage plans are. They also suggest exploring the effects of eliminating the three-day hospital stay requirement on acute and post-acute care in ACOs.
According to the study, the cost savings estimated in this research “are unlikely to be generalizable to the traditional Medicare program” because of payment differences. The study does note, however, that hospitals (rather than the Medicare program) could realize cost savings for decreased length of stay.
One thing is clear: “The policy may be inappropriately lengthening” hospital stays, Trivedi says.
Source: Health Leaders Media
http://healthleadersmedia.com/print/QUA-320205/Eliminating-Threeday-Stay-Rule-Doesnt-Add-to-LOS