While the two-midnight standard provides an increased measure of temporal clarity in setting the line between outpatient and inpatient care, a new set of records are required under the new rule because an admitting doctor's medical judgment is a critical factor in determining inpatient admission status. As CMS officials noted Friday, "The rule is based on expected length of stay."
"It's our experience in general that smaller hospitals have fewer administrative resources to deal with this," Steingart said, adding there is insufficient data at this point to quantify the impact of the new rule on administrative costs. "Larger systems tend to have more people who can look at this issue, or any issue."
Felgar agrees and says that Frisbie Hospital, a nonprofit facility with 82 beds and a high proportion of relatively short patient stays, could face decreased profits from the rule. But he said all hospitals will feel the pinch.
"It's going to hit everybody. It's a continuation of the government's efforts to reduce expenditures on healthcare," he said. "I don't see any financial upside at all. It's just another difficulty to overcome."