According to Wright et al. (2018), the rule of two-midnight health policy states that any patient expected to remain in the hospital less than two midnights should be assigned to observation, while any patient expected to remain in the hospital beyond two midnights should be considered inpatient.
According to Wright et al. (2018), long observation stay cases are classified as inpatient admissions. These clinically warranted longer hospital stays may have been prematurely truncated under old policy. However, the two-midnight rule creates additional administrative ambiguity. Not only does the policy require physicians to predict how long the patient will stay in the hospital, but that length of stay can be influenced by seemingly non-clinical external factors like time and day of the week when a particular patient presents.
Delegate your assignment to our experts and they will do the rest.
Administrative cost of complying with the rule has been estimated to exceed $2.5 billion a year, prompting Medicare Payment Advisory Commission (CMS) to recommend repealing the two-midnight rule and replacing with financial penalty on hospitals with high rates of short-stay hospitalizations. According to Wright et al. (2018), CMS implemented the rule gradually through December 2015, adopting a “probe and educate” process making additional minor revisions .
Medicare recorded the number of hours a patient is under observation. This would remove the administrative and clinical complexity of observation versus inpatient decision, eliminate variation in billing based on patient presence to emergency department and reduce confusion related to long observation stays. Potential consequence would be hospitals intentionally gaming the system to keep patients just past the length of stay threshold to ensure acceptable billing and reimbursement (Locke & Hu, 2019). However, this scenario could also be monitored with outlier hospitals penalized for this behavior.
COVID-19 has negatively affected design and operation of health care, adding to the existing constraints of two midnight policy which resulted in creation of temporary health care bills and funds by the government until end of covid-19 pandemic.
References
Wright, B., Zhang, X., Rahman, M., & Kocher, K. (2018 ). Informing Medicare’s Two-Midnight Rule Policy with an Analysis of Hospital-Based Long Observation Stays . Annals of emergency medicine, 72(2). https://doi.org/10.1016/j.annemergmed.2018.02.005
Locke, C. & Hu, E. (2019). Medicare’s two-midnight rule: The hospitalist . https://www.the-hospitalist.org/hospitalist/article/194971/medicares-two-midnight-rule
