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Robert B. Vogel, MD, JD
Retinal Ophthalmologist at Piedmont Eye Center, Lynchburg VA;
Attorney, Overbey Hawkins & Wright, PLLS, Lynchburg, VA;
Adjunct Professor, Humanities and Bioethics, Liberty University School of Medicine, Lynchburg, VA.
Short inpatient hospital stays are down under the Two-Midnight Rule, according to a new report from the Office of the Inspector General (OIG).
The OIG report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Hospital Policy,” analyzed data for Medicare Part A hospital claims and Part B outpatient claims to determine the overall effectiveness of the Two-Midnight Rule in producing savings for the Medicare system and to identify any unintended consequences of the rule. The Centers for Medicare & Medicaid Services (CMS) implemented the rule, stating that payment for services is generally appropriate when an inpatient hospital stay is expected to last at least two midnights. Exceptions exist where documentation in the medical record supports the need for inpatient treatment despite a stay of less than two midnights.
The OIG found that, in fiscal year 2014, the number of short inpatient stays decreased by 9.9%, and the number of outpatient stays increased by 11.6%. A “short stay” is defined as one that lasts less than two midnights.
The OIG also reported the following findings:
The OIG recommended CMS improve oversight of hospital billing by taking the following steps:
CMS has agreed with the OIG findings and promised to implement these initiatives to benefit the system and the beneficiaries.