Study Puts Medicare`s Three-Day Inpatient Hospital Stay in Focus

Aug. 06--Medicine has changed a lot since the 1960s, but Medicare still has in place a policy created in 1965 that requires that patients spend three days as an inpatient before they can be moved to a skilled nursing facility.

"The concern is that the policy may be unnecessarily extending the length of hospital stays. We know that every day in a hospital carries some risk, whether it's for an infection, blood clots or some other risk," said health policy researcher Amal N. Trivedi, whose study appears this week in the journal Health Affairs.

Reshaping the mandate could shorten a lot of those hospital stays, avoid medical complications and curb costs, said Dr. Trivedi, a Brown University professor who worked with several colleagues on the two-year study.

His research found the hospital stays were around 10 percent shorter for people on a handful of privately administered Medicare Advantage plans that eliminated the three-day mandate.

Because his comparison involved only 28 Medicare Advantage plans and about 258,000 enrollees, it isn't clear how the findings might translate to traditional Medicare policies that cover about 70 percent of program participants nationwide, Dr. Trivedi said.

Still, he and other industry observers said the analysis should encourage Medicare to take a fresh look at the hospitalization standard.

Program officials did not immediately discuss the study.

"You don't have to sit around the hospital waiting for lab tests. You don't have to sit around the hospital waiting for incisions to heal. We now have technology that is minimally invasive," said Howard Degenholtz, an associate professor in health policy at the University of Pittsburgh.

He said Dr. Trivedi's review follows a 40-year national trend toward shorter hospital stays encouraged by better antibiotics, rehabilitation and diagnostic techniques.

Keeping inpatient visits brief can be especially important for the elderly, who are prone to dangerous losses of muscle mass when they stop moving, Mr. Degenholtz said.

Medicare covers more than 55 million elderly and people with disabilities.

Average hospital stays could top two weeks when the Medicare policy took effect in 1965.

At that point, Medicare supporters viewed the three-day hospitalization mandate as protection, a buffer to make sure patients would not be discharged into nursing homes before doctors had finished key medical evaluations.

Now Medicare beneficiaries' average hospital stays are about five days, and "it would be reasonable for a hospital to make a determination on skilled nursing care in less than three days," Dr. Trivedi said.

At McCandless, PA-based Vincentian Collaborative System, a Catholic nonprofit that cares for more than 500 senior citizens, president Raymond E. Washburn didn't cast any blame for the three-day rule.

"We're just in a different world," said Mr. Washburn, who urged a thorough review of the regulations. He said hospitalization still makes sense to stabilize some ailing patients before they arrive in a group home.

Yet "in a lot of cases, they probably didn't need the acute-care stay at all and could have just come into the nursing home," Mr. Washburn said.

He estimated an overnight hospital stay can cost thousands of dollars, while the same night in a nursing facility can run several hundred dollars. Dr. Trivedi said he didn't know how much hospitals and the government might save by amending the hospitalization mandate. Shorter stays cited in his study saved around $1,500 on average.

At the Pennsylvania Health Care Association, which represents nursing and assisted-living homes, President W. Russell McDaid said relaxing the rule could give patients easier access to their Medicare benefits.

"We are hopeful this is the beginning of a dialogue and more study," Mr. McDaid said.

Adam Smeltz: asmeltz@post-gazette.com, 412-263-2625 or on Twitter @asmeltz. Reuters contributed.

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