Resident Physician Brown University Providence, Rhode Island, United States
Introduction: The Medicare extended care benefit, which mandates at least 3 consecutive nights of hospitalization in order to receive skilled nursing facilities (SNF) coverage, has been criticized for unnecessarily prolonging length of stay (LOS). In March 2020, this requirement was waived. We sought to evaluate whether or not this policy change has reduced the length of stay for SNF-bound neurosurgical inpatients.
Methods: We conducted a retrospective cohort study of 1,395 consecutive patients admitted to the neurosurgical service of our hospital and subsequently discharged to a SNF between January 2018 and December 2021. The primary outcome of this study was the percentage of patients discharged to SNF after inpatient LOS < 3 days (“low LOS%”). Data were analyzed with difference-in-differences analysis to compare the longitudinal differences in low LOS% between SNF-bound Medicare enrollees and SNF-bound non-Medicare patients before and after the first quarter of 2020.
Results: 845 (60.5%) patients were admitted before the 2020 waiver. Patients admitted before and after the waiver differed significantly with regard to age (69.6 vs 71.5, p = 0.014), Medicare enrollee status (64.7% vs 70.5%, p = 0.028), average LOS (6.58 days vs 8.41 days, p < 0.001), and percent admitted non-electively (55.0% vs 65.6%). On primary difference-in-differences analysis, implementation of the March 2020 waiver was not associated with subsequent change in low LOS% relative to SNF-bound non-Medicare patients and pre-waiver SNF-bound Medicare patients (estimated difference: -0.011%, standard error: 4.4%, p = 0.810). On sensitivity analysis, waiver implementation was also not associated with subsequent change in low LOS% between years 2018 and 2021 (estimated difference: -0.093%, standard error: 6.0%, p = 0.980).
Conclusion : In this single-institution analysis, implementation of the 2020 Extended Care Benefit Waiver did not result in significant differences in the proportion of SNF-bound neurosurgical Medicare beneficiaries discharged in less than 3 days relative to SNF-bound non-Medicare beneficiaries.
