Medicare's 3-Day Rule: Time for a Rethink.
A pilot study was undertaken to examine the impact of Medicare's 3-day rule on length of stay (LOS). One hundred consecutive patients who underwent primary total joint arthroplasty and were discharged to extended care facilities were retrospectively reviewed. Based on readiness for discharge criteria, delaying discharge until the third postoperative day increased LOS by 1.1 days (P<0.001). 60.6% of patients were ready for discharge by the second postoperative day, none of whom required re-admission within 30 days of discharge. There were no rehabilitation gains by staying an additional hospital day beyond readiness for discharge (P=0.092). This pilot study calls into question the value of Medicare's 3-day rule and demonstrates the feasibility and need for further research to address this seemingly antiquated policy.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Mohamad J
MJ
Halawi
Duke University School of Medicine, Durham, North Carolina.
Tyler J
TJ
Vovos
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
Cindy L
CL
Green
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Samuel S
SS
Wellman
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
David E
DE
Attarian
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Michael P
MP
Bolognesi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006291:Health Policy; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000331:legislation & jurisprudence*; D008297:Male; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000191:economics / Q000331:legislation & jurisprudence*; D010865:Pilot Projects; D011184:Postoperative Period; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D013997:Time Factors; D014481:United States
Medicare's 3-day rule; arthroplasty; length of stay; policy; rehabilitation