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Waiving 3-day hospital requirement benefits patients, Medicare Advantage plans

A recent study showed that waiving Medicare’s typical 3-day hospital stay requirement before becoming eligible for skilled nursing care would reduce hospital stays without increasing admissions or the duration of receiving skilled nursing services.

“This policy dates back to the mid-1960s, when the average length of a hospital stay was 2 weeks,” Amal N. Trivedi, MD, MPH, associate professor of health services, policy and practice at Brown University, said in a press release. “Requiring patients to stay in the hospital for 3 days before they can be transferred to a skilled nursing facility may unnecessarily lengthen hospital stays, leading to more spending, but also subject patients to unnecessary complications arising from hospital care.”

Regina C. Grebla, PhD, MPH, a researcher at the Center for Gerontology and Health Care Research at Brown University, Trivedi and colleagues performed a quasi-experimental study comparing the use of hospital and skilled nursing services in 14 Medicare Advantage plans that eliminated the 3-day requirement (n = 116,676 enrollees) with 14 traditional plans that employ the policy (n = 140,739 enrollees).

Between 2006 and 2010, hospital admission rates and lengths-of-stay in skilled nursing facilities were comparable in traditional and Medicare Advantage plans. The mean length of hospitalization increased from 6.1 days to 6.6 days among patients enrolled in the traditional plan and decreased from 6.9 days to 6.7 days among patients in the Advantage plan.

A difference-in-differences analysis yielded a net decrease of 0.7 days (P < .0001), which has the potential to reduce patients’ risk for iatrogenic complications, according to the researchers. In addition, the reduction could save approximately $1,500 for each patient discharged to a skilled nursing facility.

“These results suggest that Medicare Advantage plans may have realized cost savings by eliminating this precondition for Medicare payment,” the researchers wrote.

However, traditional fee-for-service Medicare plans that pay prospectively for hospital admissions would only benefit from eliminating the policy if acute hospitalizations were avoided, the researchers wrote. Otherwise, savings from reduced hospital stays would accrue to hospitals.

The researchers said it is unclear if accountable care organizations that share costs and potential savings with health care providers, similar to Medicare Advantage plans, would achieve similar benefits. Further research is warranted to study the effects of eliminating the 3-day policy in both traditional Medicare and accountable care organizations, they concluded. – by Stephanie Viguers

Disclosure: Grebla reports being associate director of the global health economics, outcomes research and epidemiology division at Shire Pharmaceuticals.