An old Medicare rule is keeping older adults in hospitals longer than necessary, so what can be done?
Zoey Chen, PhD candidate in health services research at Brown University, looks into this.
Faculty Bio:
Zihan Chen is a PhD candidate in Health Services Research at Brown University. She studies Medicare policy, with a focus on post-acute and long-term care.
Transcript:
Imagine this: an older adult falls at home and is hospitalized with a hip fracture. After two days, their doctor says they’re medically stable and ready to leave the hospital—to continue recovery in a nursing home with physical therapy and monitoring.
But they can’t leave.
Not because of their health—but because of a rule.
Medicare requires a minimum three-day hospital stay before it will cover care in a skilled nursing facility. This is known as the “three-day rule,” and it dates back to 1965.
More than half a century later, this rule still shapes care for millions of older adults. Many argue that the three-day threshold is arbitrary, rigid, and inefficient. However, we didn’t have strong evidence on how the rule actually affects care.
That changed in May 2023, when the rule was reinstated after being waived during the COVID-19 pandemic. This created a rare natural experiment.
What we found was surprising. After this rule was reinstated, more patients stayed in hospitals just over three days. And the increase was larger among patients with dementia or hip fracture, who were mostly likely to need post-hospital care in nursing homes. Patients didn’t use nursing homes any less, they were just staying in hospitals longer than medically necessary to qualify.
The result? Thousands of extra hospital days, higher costs for hospitals, and no clear savings for Medicare.
This highlights a bigger issue: healthcare is full of eligibility rules like this. They might be valuable, but if we don’t evaluate these rules carefully, they can end up creating bottlenecks—delaying care, increasing costs, and potentially harming patients.
Read More:
[National Library of Medicine] - Changes in Inpatient and Skilled Nursing Facility Care After the Medicare 3-Day Rule Reinstatement
