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Medicare Two-Midnight Rule Accelerated Shift To Observation Stays.
Sabrina J Poon1, Christopher J D Wallis2, Pikki Lai3
1Sabrina J. Poon (sabrina.poon@vumc.org) is an assistant professor of emergency medicine, Vanderbilt University Medical Center, in Nashville, Tennessee.
Health Affairs (Project Hope)
|November 1, 2021
Summary
The Two-Midnight rule reduced inappropriate short hospital inpatient stays but created administrative burdens. Further analysis suggests reconsidering the rule due to its limited long-term impact and ongoing costs.
Area of Science:
- Health Policy
- Hospital Administration
- Healthcare Economics
Background:
- Policies aim to shift care from inpatient to outpatient observation settings.
- The Two-Midnight rule (Centers for Medicare and Medicaid Services, 2013) guides hospital stay classifications.
- Accurate patient status determination presents administrative challenges for hospitals.
Purpose of the Study:
- To evaluate the impact of the Two-Midnight rule on hospital stay classifications.
- To assess the administrative burden and long-term effectiveness of the rule.
Main Methods:
- Analysis of hospital stay data before and after the Two-Midnight rule implementation.
- Quantification of changes in short inpatient and outpatient stays.
- Evaluation of trends and steady-state effects.
Main Results:
- Immediately post-implementation, potentially inappropriate short inpatient stays decreased by 2.0 per 1,000 beneficiaries.
- Potentially more appropriate short outpatient stays increased by 1.8 per 1,000 beneficiaries, accelerating a prior trend.
- Following initial changes, the rate of improvement reached a steady state.
Conclusions:
- The Two-Midnight rule initially improved hospital stay classifications but its long-term impact has plateaued.
- The administrative resources required for status determination may outweigh the rule's sustained benefits.
- Reconsideration of the Two-Midnight rule's value is warranted given the current steady state.
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