Insurance-Mandated Stay Prolongs Hospitalization Following Total Shoulder Arthroplasty


Medicare currently requires a 3-night hospitalization for a patient to be considered for skilled nursing facility (SNF) placement. The purpose of this study was to analyze the relationship between length of stay and (a) insurance status and (b) readmission rates in Medicare-age patients undergoing primary total shoulder arthroplasty. A retrospective review of 251 primary consecutive total shoulder arthroplasty cases was performed. In patients discharged to SNF, Medicare insurance was associated with a significantly longer hospital stay (p < .001) compared with patients with private insurance. Readmission rates for Medicare and private insurance patients were similar at 30 and 90 days after surgery (p D 1.000). Ninety-five percent of Medicare patients discharged to SNF had a prolonged hospital stay primarily to fulfill the 3-night requirement. These findings call into question the necessity of the current 3-night inpatient hospitalization requirement for facility placement following total shoulder arthroplasty. (Journal of Surgical Orthopaedic Advances 26(2):81–85, 2017) Key words: hospital readmission, length of stay, shoulder arthroplasty, 3-night rule, value-based health care

Krysten M. Bell, MD; Mark E. Mildren, MD; Montri D. Wongworawat, MD; Torrey Parry, MD; Christopher M. Jobe, MD; and Wesley P. Phipatanakul, MD