A JAMA study of 600,000 traditional Medicare hospitalizations found that the 3-day rule’s reinstatement in 2023 was not tied to changes in skilled nursing facility (SNF) discharge rates and that the share of hospitalizations lasting at least three days increased by 1.13 percentage points overall and 5.57 percentage points among those discharged to SNFs.

Brown University researchers surmised that reinstating the 3-day rule lengthened hospital stays without reducing SNF use, suggesting that the rule’s broad application may be suboptimal (“Changes in Inpatient and Skilled Nursing Facility Care After the Medicare 3-Day Rule Reinstatement.”)

In his weekly newsletter, Jay Gormley, chief investment officer, and COO, Advisory, Zimmet Healthcare Services Group, said “a critical nuance is who was studied. The analysis was restricted to new inpatient stays, meaning beneficiaries with no inpatient or SNF care in the prior 60 days.”

In other words, he said, the study mostly reflects people newly entering post-acute pathways, not existing nursing home residents who are rehospitalized and then return to the facility.

“That matters because rehospitalized long-stay residents represent a meaningful slice of Part A SNF volume, roughly 20 percent by many operators’ estimates, and they were a major cohort behind the utilization uptick seen when the 3-day rule was waived during COVID,” Gormley said.

The punchline is that for newly hospitalized beneficiaries the 3-day rule appears to function less like a utilization screen and more like a length of stay extender.

“The rule pushed inpatient days upward without reducing SNF use or improving short-term outcomes, but the study does not fully speak to the resident rehospitalization segment that was most sensitive to the waiver period when enacted,” he stressed.

Find the JAMA study at https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2844485.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.