Providers Blast CMS on Two-Midnight Rule
"Our members have had a lot of difficulty with the two-midnight rule," Allison Cohen, senior policy and regulatory analyst at the DC-based group, said in an interview last month before the AAMC filed its comments. "Duration of stay really doesn't say anything about the patient."
She says the two-midnight rule unduly punishes large academic medical centers. "Based on mission, we have to treat all comers," Cohen said, noting large medical centers in urban areas face a high volume of "high-intensity" patients such as the homeless and people from disadvantaged communities who have suffered with multiple chronic conditions for years.
"Two-midnights was designed to provide clarity when it really hasn't. Then you're also underpaying these hospitals that are treating high-intensity patients… This is really something where clinical judgment should determine whether a patient is inpatient or outpatient."
If the two-midnight rule is implemented, the AAMC wants the threshold-setting clock to start as soon as a physician orders inpatient status. AAMC officials wrote to CMS:
"At high-occupancy hospitals, such as those of the AAMC members, it is not unusual for a patient to have to wait several hours or more for a bed to become available, even after a physician has written an inpatient order…"
"For example, a physician may write an inpatient order in the emergency room at 10 p.m. on a Monday night, the patient may be moved to the inpatient setting at 1 a.m. Tuesday morning, and the patient may be discharged at 7 a.m. on Wednesday morning. Under CMS' proposal, this case would not have qualified… even though the patient required inpatient care across two midnights."
- EHR Systems 'Immature, Costly,' AMA Says
- Better HCAHPS Scores Protect Revenue
- Narrow Networks Cut Costs, Not Quality, Economists Say
- CEO Exchange: Preparing for Population Health
- Interstate Medical Licensure Effort Advances
- Anthem Blue Cross, 7 CA Health Systems Create New Challenger, Business Model
- 'Early Offer' Malpractice Programs May Spur Reform
- How to Build a Health Plan from Scratch
- 3 Strategies for Retaining Millennial Employees
- Advocate, NorthShore Deal Would Create 16-Hospital System