Does the Medicare 3-Day Rule Increase Length of Stay?

Victor Hernandez, Alvin Ong, Zachary Post, Fabio Orozco

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Medicare will only cover a stay in a skilled nursing facility (SNF) after TKA if the patient stays for at least 3 days at the inpatient hospital. The 3-day stay rule was instituted in 1965, to prevent over utilization of Medicare. We retrospectively reviewed 800 consecutive TKA, identifying patients that were discharged to rehab after surgery. 322 patients were discharged to SNF after surgery (209 Medicare, 113 private insurances). The LOS was 2.3 days for privately insured patients and 3.02 for Medicare recipients (P <0.05). No difference was found with regard to age, BMI, and ASA score. The Medicare 3-day rule independently increased the LOS in patients who required inpatient rehab, leading to increased cost. We suggest that this rule must be revised.

Original languageEnglish (US)
Pages (from-to)34-35
Number of pages2
JournalJournal of Arthroplasty
Issue number9
StatePublished - Sep 1 2015


  • 3-day rule
  • Costs
  • Medicare
  • Private insurance
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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