Study: Hospital, SNF stays don't increase when MA plans waive three-day rule

Eliminating the three-day stay requirement for Medicare Advantage enrollees does not increase hospital or skilled nursing facility admissions or SNF lengths of stay, according to a new study published in Health Affairs. While traditional Medicare requires beneficiaries to be hospital inpatients for three days before it will cover their post-acute skilled nursing care, the policy is optional for Medicare Advantage plans. The study compared changes in use of hospital and SNF care among enrollees in MA plans that did and did not eliminate the requirement between 2006 and 2010. “These results suggest that Medicare Advantage plans may have realized cost savings by eliminating this precondition for Medicare payment,” the study concludes. “Investigation of the effects of waiving this requirement on the use of acute and post-acute care in [accountable care organizations] and traditional Medicare is warranted." Unlike ACOs, MA plans also have the option of controlling costs through coverage restrictions, the use of prior authorization, increased cost sharing, and enhanced limitations on the network of available providers, the authors note.