Arbitrary determination, unintended consequences
Elizabeth Carnevale, assistant vice president for revenue cycle at South Nassau Communities Hospital, a 435-bed independent hospital in Oceanside, NY, agrees with the goal of the two-midnight rule—lowering overall healthcare costs—but says cost-cutting should not be done at the expense of good clinical care.
"I do believe that we have to address healthcare costs, and we do have to reduce costs, but I think the government is going about it the wrong way," she says. "The number of midnights a patient stays in the hospital is not a good way of making a determination. It's about the severity of the patient. I am hoping people come to use more clinical judgment on what should be [classified as] inpatient versus using the number of midnights.
"I am hoping the ruling will be repealed," she adds. "I find it very arbitrary. This is medical decision-making, it's not cookie cutter. Every patient is different, especially patients of that age, and these have to be clinical decisions. Basing decisions on this ruling is not clinically sound."
Carnevale notes that hospitals use the same amount of resources regardless of a patient's classification and incur the same cost to provide care.
"If the patient stays two midnights, whether in inpatient or outpatient status, I am still providing the same level of care, the same nursing level, the same testing. Everything is exactly the same so my costs don't change, and this is just cutting into the bottom line. The only thing that is reduced is our reimbursement. I still have the same overhead," she says.