Worn-out rule: Medicare should rethink its 3-day hospital stay

Fifty years ago hospital stays were longer, patient outcomes weren’t as good and health care in general was riskier business. So why does Medicare cling to a rule from 1965 that requires people to stay in the hospital for three days as an inpatient before being transferred to a skilled nursing care facility?

That’s the question being raised by a study that was published this month in the journal Health Affairs and led by Amal N. Trivedi, a professor at Brown University.

Trivedi’s team compared the average time that patients were hospitalized between 2006 and 2010 under privately administered Medicare Advantage insurance plans that observed the old rule or let patients move sooner to followup care at skilled nursing facilities. The hospital stays were about 10 percent shorter for people enrolled in plans that did not require the minimum three-day hospitalization.

Researchers estimated that elimination of the rule meant $1,500 in savings, to the Medicare Advantage plans involved in the study, for each admission that resulted in a move from a hospital to a skilled nursing location.

Howard Degenholtz, an associate professor in health policy at the University of Pittsburgh, told the Pittsburgh Post-Gazette’s Adam Smeltz that patients nowadays “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.”

At a time when everyone involved in health care should be trying to curb costs, why would Medicare, which covers more than 55 million Americans, continue to use a standard that is out of date and out of sync with modern medicine?

No one wants hospital inpatients to be discharged before their care warrants it, but a standard that dates to the Johnson administration deserves a hard look and, most likely, replacement.