There has been a lot of frustration around the Medicare 3-day rule, and a new study gives that frustration real support. Under this long-standing policy, Medicare covers skilled nursing facility care only if the beneficiary first has a hospital stay of at least 3 consecutive days. That stay also must occur within 30 days before admission to the SNF. A recent JAMA Internal Medicine study examining the rule’s reinstatement on May 12, 2023, found that it was associated with longer inpatient stays but not with lower SNF use or better short-term outcomes.
Researchers found that after the 3-day rule returned following the COVID-era waiver, more hospitalizations lasted at least 3 days. This trend appeared from January through November 2023. The change was even more noticeable in some clinical subgroups. That included patients with dementia and those hospitalized for hip fracture. The researchers reported that the reinstatement increased the likelihood of a hospital stay lasting at least 3 days by 1.13 percentage points overall. Among patients discharged to SNFs, that increase was 5.57 percentage points.
That is the part that stands out. The rule appears to be adding inpatient days without producing the results it was meant to achieve. The same study found no significant changes in the overall probability of SNF discharge. It also found no significant changes in 30-day rehospitalization, 30-day mortality, Medicare spending, or total SNF days. In other words, the policy seems to prolong hospital stays without improving outcomes. It also does not appear to reduce use in the way many assumed it would.
McKnight’s Long-Term Care News also highlighted the study’s conclusion that the federal 3-day rule may be backfiring rather than functioning as an effective screening tool for post-acute SNF care. These findings raise important questions about whether the Medicare 3-day rule still has value in the traditional Medicare program. They also raise questions about whether it is simply creating more burden for hospitals, clinicians, and residents. For those of us who have questioned this requirement for years, this feels like a meaningful step in the right direction. Now we wait to see whether policy follows the evidence.
Stay well and stay informed!
