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 Researchers compared the average time patients were hospitalized
between 2006 and 2010 in privately administered Medicare Advantage
health plans that either stuck to this rule or allowed people to
transfer to skilled nursing facilities sooner.
Lengths of hospital stays increased with the rule in place and
declined when it was waived, the study found.
“The three-day stay rule may inappropriately lengthen the time spent
in a hospital for patients who could be transferred to a skilled
nursing facility earlier,” senior author Dr. Amal Trivedi, a health
policy researcher at Brown University in Providence, Rhode Island,
said by email.
This minimum-stay rule dates back to the 1960s, when patients
typically remained in the hospital for nearly two weeks, and three
days was the minimum time needed to evaluate them and plan their
post-hospital care, Trivedi and colleagues note in the journal
Health Affairs.
Since then, typical stays have shortened, and skilled nursing
facilities have become an increasingly common treatment setting for
patients with complex medical problems who no longer require acute
inpatient care.
To see how the three-day minimum stay requirement might impact
hospitalization, researchers compared the typical number of hospital
days for nearly 141,000 patients in 14 Medicare Advantage plans that
upheld the rule and for nearly 117,000 people in 14 similar plans
that waived it.
The people enrolled in plans that waived the rule were typically
younger, poorer and less likely to be white.
For plans that waived the rule, 23.5 percent of hospitalized
patients were admitted to skilled nursing facilities in the year
before the rule was eliminated, compared with 25.7 percent in the
year after it went away.
Plans that kept the rule saw a similar gain, from 22.8 percent to
26.3 percent.
But the average length of hospital stays for patients in plans that
waived the three-day rule declined from 6.9 days to 6.7 days,
compared with an increase from 6.1 days to 6.6 days in plans that
kept the requirement in place.
Overall, the average reduction in hospital stays was 0.7 days with
the rule elimination, translating into approximately $1,500 in
savings for every admission that ended with a transfer to a skilled
nursing facility, the researchers estimated.
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One limitation of the study, however, is that it looked at hospital
days over the entire year, rather then the number of days for each
stay, the researchers acknowledge. It’s also possible that the cost
savings wouldn’t be the same for people with traditional
fee-for-service Medicare or other plans unlike the ones in the
study.
Even so, as hospital stays become shorter and patients with
complicated illnesses are treated in other settings, it makes sense
to revisit whether the three days is the right cutoff to identify
people who can appropriately transfer to a skilled nursing facility,
said David Grabowski, a health policy researcher at Harvard Medical
School in Boston.
Certain patients may also benefit from leaving the hospital sooner,
because longer stays can increase their risk of infections and make
it less likely that they get out of bed for physical activity that
can aid recovery, Grabowski, who wasn’t involved in the study, said
by email.
“Some individuals with short hospital stays may be inappropriately
excluded from skilled nursing facility care under the current
system,” he said. “Moreover, this rule has led to some unintended
consequences like the growth in observational stays.”
“There really aren’t many benefits to staying beyond medical
necessity,” Grabowski added.
SOURCE: http://bit.ly/1VZXmXS Health Affairs, online August 2015.
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