The Cost of Unnecessary Hospital Days for Medicare Joint Arthroplasty Patients Discharging to Skilled Nursing Facilities

Q: What is the 72-hour Medicare mandate being studied?

The mandate requires a consecutive 3-day inpatient stay (3-night rule) for patients discharging to skilled nursing facilities (SNFs). It applies to Medicare patients undergoing total joint arthroplasty.

Q: How did the study estimate costs for earlier vs later SNF discharge?

It queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for primary TJAs performed in 2015, recorded discharge destination, and used institutional cost accounting to compare costs for discharges on POD #2 versus POD #3.

Q: What financial impact did the authors find for a 3-day versus 2-day length of stay?

For THA, 3-day stays incurred $2014 more hospital costs, while for TKA they incurred $1814 more, compared with a 2-day stay (P < .001). The study extrapolated these findings to estimate about $63 million in annual national savings if earlier safe discharge were allowed.

Oct 27, 2026

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Debate surrounds the 72-hour Medicare mandate (3-night stay rule), which obligates a consecutive 3-day inpatient stay for patients discharging to skilled nursing facilities (SNFs). Prior evidence suggests 48%–64% of Medicare total joint arthroplasty (TJA) patients are clinically safe for SNF discharge on postoperative day (POD) #2. This study quantifies the financial impact of requiring additional inpatient days for discharge on POD #3 rather than POD #2, using institutional cost accounting.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Article overview

Background and objective

Methods

Results

Conclusion

The Journal of Arthroplasty xxx (2017) 1e3 Contents lists available at ScienceDirect The Journal of Arthroplasty journal [homepage:](homepage: www. arthro plastyjournal. org)[ www. arthro plastyjournal. org](homepage: www. arthro plastyjournal. org) | Original Article
The Cost of Unnecessary Hospital Days for Medicare Joint Arthroplasty Patients Discharging to Skilled Nursing Facilities
Udai S. Sibia, MD, MBA a, Justin J. Turcotte, MBA b, James H. MacDonald, MD a, Paul J. King, MD a, *
a Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, Maryland b Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland | | | --- | --- | | a r t i c l e i n f o | a b s t r a c t
Background: The 72-hour Medicare mandate (3-night stay rule) requires a 3-day inpatient stay for patients discharging to skilled nursing facilities (SNFs). Studies show that 48%-64% of Medicare total jointarthroplasty (TJA) patients are safe for discharge to SNFs on postoperative day (POD) \#2. The purpose of this study was to extrapolate the ﬁnancial impact of the 3-night stay rule.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all primary TJAs performed in 2015. Discharge destination was recorded. Institutional cost accounting examined costs for patients discharging on POD \#2 vs POD \#3.
Results: A total of 42,423 TJAs (14,395 total hip arthroplasties [THAs] and 28,028 total knee arthroplasties [TKAs]) were performed in patients over the age of 65 years. Of these patients, 5252 THAs (36 . 5%) and 12,022 TKAs (42.9%) were discharged from the hospital on POD \#3, with 2404 THAs (16.7%) and 5083 TKAs (18.1%) being discharged to SNFs. Institutional cost accounting revealed hospital costs for THA were $2014 more, whereas hospital costs for TKA were $1814 more for a 3-day length of stay when compared with a 2-day length of stay (P < .001). The mean charge per day for an SNF was $486.
Conclusion: The National Surgical Quality Improvement Program database is a representative sample of all surgeries performed in the United States. Extrapolating our ﬁndings to all Medicare TJAs nationally gives an estimated $63 million in annual savings. Medicare mandated, but potentially medically unnecessary inpatient days at a higher level of care increase the total cost for TJAs. Policies regarding minimum stay requirements before discharge should be re-evaluated.
© 2017 Elsevier Inc. All rights reserved. | | Article history:
Received 5 January 2017
Received in revised form
13 March 2017
Accepted 24 March 2017
Available online xxx | | | Keywords:
American College of Surgeons National Surgical Quality Improvement Program Medicare 3-day rule
costs
total joint arthroplasties
skilled nursing facilities | | The necessity of the 72-hour Medicare mandate (3-night stay rule), which requires a consecutive 3-day inpatient stay for patients discharging to a skilled nursing facility (SNF) has been the subject of debate in the orthopedic literature [1e3] . Studies have shown that 48%-64% of Medicare 3-day length of stay (LOS) patients undergoing total joint arthroplasties (TJAs) are safe for early discharge to SNFs on postoperative day (POD) \#2, yet must remain in the inpatient setting to satisfy the 3-night stay requirement [1e3] . Although these works questioned the One or more of the authors of this paper have disclosed potential or pertinent conﬂicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical ﬁeld which may be perceived to have potential conﬂict of interest with this work. For full disclosure statements refer to [http://dx.doi.org/10.1016/j.arth.2017.03.058](http://dx.doi.org/10.1016/j.arth.2017.03.058) . * Reprint requests: Paul J. King, MD, Center for Joint Replacement, Anne Arundel Medical Center, 2000 Medical Parkway, Suit

FAQs

What is the 72-hour Medicare mandate being studied?

The mandate requires a consecutive 3-day inpatient stay (3-night rule) for patients discharging to skilled nursing facilities (SNFs). It applies to Medicare patients undergoing total joint arthroplasty.

How did the study estimate costs for earlier vs later SNF discharge?

It queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for primary TJAs performed in 2015, recorded discharge destination, and used institutional cost accounting to compare costs for discharges on POD #2 versus POD #3.

What financial impact did the authors find for a 3-day versus 2-day length of stay?

For THA, 3-day stays incurred $2014 more hospital costs, while for TKA they incurred $1814 more, compared with a 2-day stay (P < .001). The study extrapolated these findings to estimate about $63 million in annual national savings if earlier safe discharge were allowed.

Oct 27, 2026

Upload by Himbo