Medicare”s Three-Day Hospitalization Requirement Prolongs Length of Stay

FRIDAY, Feb. 13, 2026 (HealthDay News) — Reinstating Medicare”s three-day hospitalization requirement was associated with longer inpatient stays, with no change in skilled nursing facility (SNF) utilization, according to a study published online Feb. 9 in JAMA Internal Medicine.

Zihan Chen, M.P.P., from the Brown University School of Public Health in Providence, Rhode Island, and colleagues conducted a retrospective cohort study of Medicare beneficiaries with acute care hospitalizations to examine changes in association with reinstatement of the three-day hospitalization rule for SNF care on May 12, 2023. Data were included from hospitalizations from January and November 2023; changes in inpatient length of stay, SNF utilization, spending, and short-term health outcomes were assessed.

A total of 332,044 unexposed hospitalizations and 338,375 exposed hospitalizations were included. The researchers found a 1.13 percentage point increase in the likelihood of an inpatient stay lasting at least three days with reinstatement of the three-day rule. Among patients discharged to SNFs, reinstatement of the three-day rule increased the probability of at least three-day hospitalization by 5.57 percentage points. There were no significant changes in the overall probability of SNF discharge, 30-day rehospitalization, 30-day mortality, Medicare spending, or total SNF days. Greater increases in at least three-day stays were seen for patients hospitalized with hip fractures and patients with dementia.

“We found that the rule does not reduce skilled nursing care use among patients who are admitted to the hospital, as was its original purpose, but instead led to longer hospital stays to meet requirement for coverage,” Chen said in a statement.

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