In case you missed it, researchers from Brown University recently published a new
study on Medicare’s three-day hospital stay requirement, which purports to curb Medicare spending and the unnecessary use of skilled nursing care. The study, published in JAMA Internal Medicine, found that the long-standing requirement actually does the opposite: it lengthened hospital stays without reducing utilization rates of skilled nursing facilities (SNF), resulting in additional health care costs yet no improvements in patient health outcomes. In the study’s conclusions, the researchers offer the following assessment of the rule’s effectiveness:
“This study provides rigorous empirical evidence that the 3-day rule may not serve its intended function of screening unnecessary post-acute SNF use and instead results in additional inpatient days that burden hospitals, clinical practice, and potentially patients.”
“This is a classic example of the red tape that often surrounds access to care for seniors,” said Clif Porter, president and CEO of the American Health Care Association. “Skilled nursing care must be available to beneficiaries when their doctors and medical care teams deem it appropriate. We must let go of antiquated requirements that force seniors to wait in hospitals and delay their recovery. It’s time to stop burdening families, overwhelming hospitals, and wasting health care dollars.”
The national study examined beneficiaries on traditional Medicare who were hospitalized from January to November 2023 once the three-day hospital stay was reinstated after the policy’s temporary pause due to the COVID-19 public health emergency. As covered by both
McKnight’s Long-Term Care News and
Skilled Nursing News, researchers found that reinstating the three-day stay requirement led to longer inpatient stays. The proportion of hospitalizations lasting at least three days increased overall (1.13 percentage points) and among those discharged to SNFs (5.57 percentage points). However, the study also found that no significant changes were observed in the overall probability of SNF discharge, 30-day rehospitalization, 30-day mortality, Medicare spending, or total SNF days.
Of particular concern from the Brown University study is the finding that hospital stays were noticeably longer for certain patient groups, including patients with dementia, while having no impact on the beneficiaries’ ultimate use of a skilled nursing facility. Extended hospital stays increase “the marginal risk of adverse events” for current patients and “can delay care and exacerbate health risks for patients who need inpatient care.”
For years, AHCA has voiced concern over the three-day stay requirement and supported common-sense policies like the Improving Access to Medicare Coverage Act of 2025. The legislation would allow days spent at the hospital under “observation” to count towards Medicare’s three-day minimum.
AHCA also supports a full repeal of the three-day stay requirement, an arbitrary timeline established decades ago that Medicare Advantage plans, Accountable Care Organizations (ACOs), and several Medicare bundled payment demonstration models are permitted to waive. Many hospitals try to find ways to extend the inpatient stay to meet the requirement and make sure patients receive the care needed without having to foot the bill. This red-tape effect was recently referenced on HBO’s fictional medical drama, “The Pitt,” in which the hospital finds a way to admit a patient with dementia even though she could be discharged to a nursing home immediately to meet the three-day requirement.
The study authors encourage Washington to reconsider the rule’s effectiveness even more broadly, noting “policymakers may consider waiving the 3-day rule for inpatient admissions as a feasible starting point for reform with minimal fiscal and health impacts.”
Long term and post-acute care play a critical role in the nation’s overall health care continuum. As demonstrated by the study, access to the right care, at the right time, and in the right place can help ensure that patients are receiving high-quality care and create overall health care efficiencies.
Access the JAMA Internal Medicine study HERE.