Specifically, the Brown University research team found that between 2006 and 2010 the average time in the hospital per year increased by half a day among 140,739 people in 14 plans that never waived the rule, but decreased by 0.2 days among 116,676 people in 14 otherwise similar plans after they waived it. That net difference of 0.7 fewer days on average in the hospital -- a 10 percent relative reduction -- likely saved Medicare Advantage plans money, but also meant less time before patients could move to the next phase in their recovery and less time when they were at risk of experiencing hospital-acquired complications, such as an infection or blood clot.
"This policy dates back to the mid-1960's, when the average length of a hospital stay was two weeks," said Dr. Amal Trivedi, associate professor of health services, policy and practice at Brown University and corresponding author of the study in the August issue of Health Affairs. "Requiring patients to stay in the hospital for three days before they can be transferred to a skilled nursing facility may unnecessarily lengthen hospital stays, leading to more spending, but also subject patients to unnecessary complications arising from hospital care."
Meanwhile, the researchers found no evidence of several potential negative consequences of waiving the rule: Did members of plans that waived the rule have more skilled nursing admissions? No. Were they in skilled care for longer? No.
The researchers also checked to see if patients in rule-waiving plans had more hospital admissions. They did not.
"It wasn't as if discharging them early and letting the patients go to the nursing home just led to the patient going back into the hospital," said lead author Regina Grebla, a Brown alumna and research consultant.