7 Statistics on the Clinical Impact of the Two-Midnight Rule

Data from the University of Wisconsin Hospital and Clinics and the American Family Children's Hospital, both in Madison, found more patients will be billed as observation status under the two-midnight rule, opposite of CMS' prediction that more patients will be billed as inpatients, according to a study in the Journal of Hospital Medicine.

Researchers examined data of all observation and inpatient visits at the medical centers, more than 31,000, between Jan. 1, 2012 and Feb. 28, 2013.

They found a net transition of 14.9 percent from inpatient status to observation status for all encounters.

Here are six more statistics on the clinical impact of the two-midnight rule from the study.

•    Looking solely at Medicaid encounters, researchers found a net transition of 7.4 percent from inpatient status to observation status.

•    For adult general medicine, the study showed a 2.2 percent decrease in inpatient status for all insurance types, but there was a 2.4 percent increase in inpatient status for Medicare patients.

•    Time of admission may affect patient status, as observation encounters admitted before 8 a.m. lasted two midnights 13.6 percent of the time, and observation encounters admitted after 4 p.m. lasted two midnights 31.2 percent of the time.

Researchers suggest "CMS should define observation care per its original intent: as a means to determine if a patient can safely return home after a short period of additional care. Patients whose conditions necessitate an intensity and level of service beyond this narrow scope should be classified as full inpatients irrespective of [length of stay], whether that LOS is <2 midnights or ≥2 midnights," according to the report.

More Articles on the Two-Midnight Rule:

CMS Delays Two-Midnight Rule
Hospital Leaders to Congress: Two-Midnight Rule is Arbitrary, Confusing
Hospitals Move Forward With Two-Midnight Rule Challenge

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