OBJECTIVES: CMS released an update to the 2013 2-midnight rule, effective for 2016, expanding a physician’s ability to admit patients under Medicare Part A who are expected to require less than two midnights of hospital care. We sought to quantify the impact of this change on rates of inpatient admissions and lengths of stay (LOS) for patients having cardiac catheter ablation. These procedures had high rates of extended observational outpatient stays based on the original rule.

METHODS: Patient-level de-identified hospital records from 2013-2016 were extracted from the MedAssets hospital database. Visits for adults (age 18+) with a primary diagnosis of atrial fibrillation, atrial flutter, ventricular tachycardia, or supraventricular tachycardia and a procedure code for catheter ablation of the associated arrhythmia were included, provided that they did not have additional codes for AV node ablation, endoscopic or surgical ablation, surgical left atrial appendage exclusion, valve surgery, or cardiac implant. The primary outcomes were inpatient/outpatient visit status and LOS by insurance type (Medicare/commercial) and year.

RESULTS: A total of 11,398 commercial and 15,430 Medicare ablation visits met all inclusion criteria. The percentage of inpatient visits remained constant from 2015 to 2016 for patients with commercial insurance (32.4% to 32.7%, p=0.8511) but increased for those with Medicare (45.0% to 50.0%, p=0.0002). Similarly, the percentage of patients with single night LOS remained constant from 2015 to 2016 for the commercially insured (30.1% and 30.1%, p=0.9714) while decreasing for Medicare patients (25.5% to 20.2%, p<0.0001).

CONCLUSIONS: In cardiac catheter ablation patients, the change to the CMS 2-midnight rule increased the percentage of Medicare patients admitted as inpatients and staying two or more nights. This increase impacts hospital reimbursement rates and patient eligibility for Medicare payment of skilled nursing care upon discharge.