Geriatrician: Eliminate Medicare's 3-night rule

Doing away with the requirement that Medicare recipients spend three nights in a hospital to qualify for nursing home coverage could reduce costs and patient risk, according to an editorial published in the Journal of the American Medical Association.

Part of the problem with the three-night rule is that it potentially creates an incentive for unnecessary hospitalization, wrote Lewis Lipsitz, M.D., of Hebrew SeniorLife, an affiliate of Harvard Medical School and the largest provider of elder care in the Boston metropolitan area.  

The three-night rule was first implemented alongside Medicare's extended care benefit in 1965, when it typically took three days to admit and evaluate patients and develop a care plan for them before discharge. Now, however, the process typically only takes one or two days, Lipsitz wrote.

Since 1982, the Tax Equity and Fiscal Responsibility Act permitted waivers, provided the elimination of the rule neither increased Medicare costs nor hurt the program's acute care orientation, according to the editorial.

Around the same time, he wrote, the Health Care Financing Administration, now the Centers for Medicare & Medicaid Services, analyzed test projects in Oregon and Massachusetts that eliminated the rule and found an estimated annual net Medicare savings of more than $180,000 in Oregon and more than $120,000 in Massachusetts. The HCFA elected to keep the rule in place, as these savings applied to the entire Medicare population were not particularly large and the lack of the rule did not discernibly affect quality of care.

Earlier this month, Don Berwick, M.D., former administrator for the Centers for Medicare & Medicaid services, also called for the elimination of the rule, telling the Boston Globe that because of the rule, "[t]he patient ends up holding the bag, and that's not fair or appropriate." A commission appointed by Congress to analyze long-term healthcare solutions recently made the same recommendation, FierceHealthcare previously reported.

To learn more:
- here's the Lipsitz editorial