title: Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
abstract: The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted.
authors.affiliation: Regina C. Grebla is a researcher in the Center for Gerontology and Health Care Research at Brown University, in Providence, Rhode Island, and associate director of the Global Health Economics, Outcomes Research, and Epidemiology Division at Shire, in Lexington, Massachusetts.
authors.forename: Regina C
authors.initials: RC
authors.lastname: Grebla
authors.affiliation: Laura Keohane is a PhD candidate in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health.
authors.forename: Laura
authors.initials: L
authors.lastname: Keohane
authors.affiliation: Yoojin Lee is a biostatistician in the Center for Gerontology and Health Care Research at Brown University.
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Lewis A. Lipsitz is a professor of medicine at Harvard Medical School and director of the Institute for Aging Research at Hebrew SeniorLife, both in Boston, Massachusetts.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.affiliation: Momotazur Rahman is an investigator in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health.
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Amal N. Trivedi (amal_trivedi@brown.edu) is an associate professor in the Department of Health Services, Policy, and Practice at Brown University and core investigator in the Center of Innovation in Long Term Services and Supports at the Providence Veterans Affairs Medical Center, in Rhode Island.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012866:Skilled Nursing Facilities / Q000458:organization & administration*; D014481:United States
keywords: Long-Term Care; Managed Care - Medicare < Managed Care; Medicare