Impact of Medicare's Three-Day Rule on Hospital Stays and SNF Utilization

The reinstatement of Medicare's three-day hospitalization rule has notably impacted inpatient stays and the utilization of skilled nursing facilities (SNFs), according to a study published in JAMA Internal Medicine. Conducted by Zihan Chen from Brown University School of Public Health, the retrospective cohort study assessed data from Medicare beneficiaries hospitalized from January to November 2023. This research highlights significant insights into regulatory compliance requirements and their effects on healthcare providers and patients.

The study specifically examined the consequences of reapplying the three-day hospitalization requirement for SNF coverage beginning May 12, 2023. It reviewed inpatient stay durations, SNF utilization, spending, and short-term health outcomes. Findings revealed a 1.13 percentage point rise in the likelihood of hospital stays extending beyond three days post-rule reinstatement, with a more substantial increase of 5.57 percentage points among patients discharged to SNFs. Despite these changes in hospital stay durations, SNF discharge rates, 30-day rehospitalization, and mortality remained stable, as did Medicare spending and the total days spent in SNFs. Notably, patients with hip fractures and dementia experienced the most significant increases in longer hospital stays.

Zihan Chen remarked, "We found that the rule does not reduce skilled nursing care use among patients who are admitted to the hospital, as was its original purpose, but instead led to longer hospital stays to meet the requirement for coverage." These findings carry important implications for understanding how regulatory frameworks affect hospital operations and patient management within Medicare services.