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Area of Science:

  • Orthopedic Surgery
  • Health Services Research
  • Geriatric Medicine

Background:

  • Medicare mandates a 3-night inpatient hospital stay for skilled nursing facility (SNF) eligibility.
  • Total shoulder arthroplasty (TSA) is a common procedure with varying post-operative care pathways.

Purpose of the Study:

  • To examine the association between length of hospital stay and insurance status (Medicare vs. private) in patients undergoing primary TSA.
  • To investigate the relationship between insurance status and readmission rates after primary TSA.

Main Methods:

  • Retrospective review of 251 consecutive primary TSA cases.
  • Analysis of hospital length of stay and 30/90-day readmission rates.
  • Comparison between Medicare and privately insured patient groups.

Main Results:

  • Medicare patients discharged to SNFs had significantly longer hospital stays compared to privately insured patients (p < .001).
  • Readmission rates at 30 and 90 days were comparable between Medicare and private insurance groups (p = 1.000).
  • 95% of Medicare patients discharged to SNFs experienced extended hospital stays solely to meet the 3-night requirement.

Conclusions:

  • The mandatory 3-night hospital stay for SNF placement may be unnecessary for Medicare beneficiaries undergoing TSA.
  • Current Medicare policy may lead to prolonged hospitalizations without demonstrable clinical benefit regarding readmission rates.
  • Re-evaluation of the 3-night rule for SNF eligibility after TSA is warranted.