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Providers Blast CMS on Two-Midnight Rule

Christopher Cheney, for HealthLeaders Media, July 1, 2014

An Argument for the Prior Standard
The two-midnight rule is, in part, designed to address a spike in outpatient care over the past decade. But it misses the mark, according to Joseph Dawood, MD, medical director at Tacoma, WA-based Multicare Health System. In his comments to CMS about the proposed 2015 IPPS rules, Dawood calls on the agency to "eliminate" the two-midnight rule.

"It defeats the purpose of why the rule was instituted in the first place," he said in an interview after submitting his comments to CMS last month, asserting that the proposed rule is arbitrary and penalizes efficient care. "Certain things can be treated in the outpatient setting. Other things can't. They're in between."

Dawood says the prior standard for determining inpatient status makes more sense. "It was good to begin with. Medical necessity was equivalent to inpatient status," he said of the prior standard. "If you want to find a way to pay for short-term patient stays … find a way to pay for short-term patient stays, and keep the determination of medical necessity to physicians."

Officials at the Association of American Medical Colleges say the two-midnight rule would disproportionately hit the group's membership. The AAMC filed its 2015 IPPS comments on June 25.

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