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Worn-out rule

Worn-out rule

Fifty years ago, hospital stays were longer, patient outcomes weren’t as good, and health care was generally riskier. So why does Medicare cling to a rule from 1965 that requires people to stay in the hospital for three days as inpatients before they can be transferred to a skilled nursing care facility?

That’s the question raised by a new study published in the journal Health Affairs and led by Amal Trivedi, a professor at Brown University. Dr. Trivedi’s team compared the average time that patients were hospitalized between 2006 and 2010 under privately administered Medicare Advantage insurance plans that observed the old rule, or let patients move sooner to follow-up care at skilled nursing facilities.

Hospital stays were about 10 percent shorter for people enrolled in plans that did not require the minimum three-day hospitalization. Researchers estimated that elimination of the rule meant $1,500 in savings to the Medicare Advantage plans involved in the study for each admission that resulted in a move from a hospital to a skilled nursing location.

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At a time when everyone involved in health care should be trying to curb costs, why would Medicare — which covers more than 55 million Americans — continue to use a standard that is out of date and out of sync with modern medicine?

No one wants hospital inpatients to be discharged before their care warrants it. But a standard that dates to the Johnson administration deserves a hard look and, most likely, replacement.

First Published August 17, 2015, 4:00 a.m.

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