Docs, hospitals protest two-midnight rule

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A new policy meant to reduce the number of hospital observation stays should be delayed, and stakeholders should collaborate on a better way to achieve that goal, according to the American Medical Association and American Hospital Association.

The “two-midnight rule” took effect Oct. 1. It calls for hospital stays that span two or more midnights to be considered “reasonable and necessary” for inpatient status. 

The new rule likely would decrease the number of hospital patients kept in observation status for days. A Medicare beneficiary must spend three midnights as an inpatient to qualify for skilled nursing coverage, so observation stays can saddle people with high costs for subsequent care. 

Yet the new rule is too complicated and discounts physicians' determinations about what level of care is needed, the AMA and AHA stated in a Nov. 8 letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. 

The groups want CMS to delay implementation until Oct. 1, 2014. They urged CMS to bring “affected stakeholders” together to “develop alternate policy solutions” to address observation stays. 


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