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From Health Law Daily, September 17, 2013

Three-day hospital stay requirement prior to SNF stay should be abolished according to elder care specialist

By Paul Clark

Current CMS policy requiring Medicare patients to have a three-day inpatient hospital stay before qualifying for skilled nursing care “contributes to suboptimal care and increased costs attributable to avoidable hospitalizations,” according to a viewpoint piece published in the Journal of the American Medical Association. Lewis A. Lipsitz, M.D., with the Hebrew Senior Life Institute for Aging Research urged replacing the three-day requirement with a system that looks at how a patient is functioning when determining whether he or she should be admitted to a skilled nursing facility.

Background. The three-day minimum stay requirement has been a part of Medicare law since the beginning of the program. Lipsitz noted that in 1965, “it usually took 3 days for a Medicare patient to be admitted and evaluated, to have a care plan developed, and to be discharged.” Currently, it takes a day or two for this evaluation to occur. Although the law has been amended a couple of times to allow waiver of the three-day-stay requirement under certain circumstances, the requirement has never been completely replaced.

A waiver of the three-day-stay requirement has also been granted for Medicare managed care plans, special needs plans, and the Program for All-Inclusive Care of the Elderly. Lipsitz noted that these waiver programs “have have demonstrated modest cost savings and increased patient satisfaction, but this may be attributable to intensive case management and enhanced community-based services for beneficiaries at risk of hospitalization” rather than waiver of the three-day-stay requirement.

Recommendation. Lipsitz suggested that CMS “could implement specific functional criteria for skilled nursing care, such as an acute decline in mobility, impairment in activities of daily living, or presence of delirium, and use the savings from reduced hospitalizations to provide appropriate payments for home-based and nursing home–based treatments.”

The federal Commission on Long-Term Care also recently recommended that the three-day hospital stay requirement to qualify for skilled nursing facility services should be abolished.

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