- Associated Press - Sunday, June 22, 2014

FORT WAYNE, Ind. (AP) - It’s called the two-midnight rule, and some hospitals want to avoid it like a measles epidemic.

Federal officials want to make sure that hospitals are admitting only those patients who really need extended expert medical care, which is expensive. So they drafted a plan to audit Medicare claims for inpatients whose hospital stays are shorter than two midnights.

The theory is that any patient who stays in the hospital longer than that legitimately needs to be there.

There are potential benefits to the rule. Cutting hospital reimbursements for one-night stays would reduce federal health care spending. Also, federal officials say the new rule establishes criteria for when a hospital must admit a patient rather than letting the person linger in observation status.

But hospitals fear this is just the government’s way of weaseling out of paying for expensive medical care that health care professionals have already provided. They say inpatient status has always applied to patients who stay in a hospital room one night, and the government hasn’t made a compelling argument why that should change.

Consumers are caught in the middle. Taxpayers surely endorse lower federal spending on health care. But patients and their families want to ensure that, above all, appropriate medical decisions are being made in their case.

Hospitals could conceivably respond by keeping patients longer to make sure they exceed the two-midnight threshhold that could trigger an audit.

Or they could release patients who would benefit from one overnight in the hospital.

Local hospital officials say that’s a trap they won’t fall into - even if they risk having more claims audited.

Federal officials adopted the two-midnight rule last year, setting an effective date of Oct. 1, 2013. But they have pushed back enforcement three times to allow federal officials more time to write clear guidance on how to comply. The most recent delay extends implementation until after March 31, 2015.

In the meantime, the American Hospital Association and a coalition of hospitals have filed a challenge to the changes, and Congress is considering bipartisan bills that specifically address the issue.

The difference between how much it costs to be treated in the emergency room and how much it costs to spend one day as a hospital patient is considerable.

Actually, it’s less than half.

The U.S. average cost for one day as an inpatient was $1,960, according to the Kaiser Family Foundation, which used 2011 data. The charge for an emergency department visit that didn’t result in admission was $969, according to the U.S. Department of Health and Human Services, which used 2010 data.

In Indiana and Ohio, the average cost of each inpatient day was even higher: $2,025 in Indiana and $2,170 in Ohio.

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