1. Medicare’s 2 Midnight Rule On October 1, 2014, Medicare implemented the new 2 midnight rule This is a way for Medicare to: Decrease hospital appeals as a result of aggressive RAC, MAC, QIO and OIG auditing Decrease inpatient costs Decrease costs associated with high dollar one day stay procedures such as cardiac stents Shift some of the cost to the patient - oral medications are not covered by Medicare B

2. What does this mean for UK HealthCare?? Inpatient only procedures scheduled as OPDA

3. What does this mean at UK HealthCare?? Non-Inpatient only procedures scheduled as OPSS

4. When an admission order is written, the physician must state the anticipated length of stay as > or < 2 midnights

5. Medicare’s 2 Midnight Rule *There is a general feeling that outpatient observation or short stay cost the patient more out of pocket than an inpatient stay. * Patient advocacy groups like the Medicare Advisory Group have sued the government over the increased use of outpatient hospital care * Patients cannot use their Medicare nursing home benefits if they are admitted as outpatient * NBC reported on the high cost of outpatient stay to the patient two times since January and told Medicare recipient to ask if they are inpatient or observation and tell the physician to make them an inpatient.

6. Medicare’s 2 Midnight Rule Common scenario: Planned surgery is not on the inpatient only list Clinic schedules surgery as outpatient short stay Resident writes inpatient admit order UR nurse gets order changed to outpatient short stay but must notify the patient as required by Medicare Patient doesn’t understand the impact of the change

7. Medicare’s 2 Midnight Rule Recently the patient is becoming an informed consumer. Since outpatient and observation are considered more costly, when we speak to the patient about changing to outpatient, they become very upset. Due to incorrect information, the patient believes if they complain enough, they will remain inpatient. Biggest complaint from the patient is finding out about the outpatient status after the procedure is done.

8. Medicare’s 2 Midnight Rule What can you do? Patients are telling us they want to know they will be in outpatient status before they have surgery. Plan: We are exploring the possibility of allowing a short stay patient to use their own medication to decrease patient cost.