Medicare pilot programs waive three-day admission rule for senior patients

Medicare officials are piloting experimental programs across dozens of U.S. hospitals to find out whether dropping the requirement that limits nursing home coverage to seniors admitted to the hospital for at least three days can reduce costs and improve care, Kaiser Health News reported.

Patients at these various hospitals are exempt from the requirement under a provision of the Affordable Care Act that created the Center for Medicare & Medicaid Innovations to find ways to improve Medicare, according to the article. If the tests are successful, the government can extend the pilot nationwide, said Medicare Deputy Administrator Sean Cavanaugh.

Under the three-day hospital admission rule, about 1.8 million seniors didn't qualify for nursing home coverage in 2012 because they fell under hospital observation care instead of being admitted.

Massachusetts General Hospital in Boston started offering the waiver as part of the program in April. "It gets patients to the care they need much quicker and prevents them from clinically declining at home," said Eric Weil, clinical affairs associate chief for the general internal division at the hospital. Less time in the hospital means more resources for sicker patients and more money for Medicare because home healthcare is cheaper than a hospital stay, Weil told KHN.

"The patient ends up holding the bag, and that's not fair or appropriate," Don Berwick, M.D., former administrator for the Centers for Medicare & Medicaid Services, said last year, FierceHealthcare previously reported. "Medicare should get rid of that rule."

Under one experimental program involving 600,000 seniors at more than 170 hospitals in accountable care organizations, patients who spend little or no time in the hospital can still get Medicare's nursing home benefit--Medicare makes a set payment for the patient, split between the providers and the nursing home, according to the article. The waiver also covers patients kept for observation, and there's also a bundled payment initiative waiver program.

Hospital officials warn the waivers should be used sparingly to make sure patients don't leave before they're ready, and only go to a nursing home if they have potential for short-term rehabilitation, according to KHN.

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