Variation in Hospital Visiting Hour Policies in Acute Care Facilities in Four U.S. States: An Exploratory Cross-Sectional Analysis.

Abstract

Hospital visiting-hour policies vary widely across the USA. The structural factors shaping that variation remain poorly characterized, particularly in different state policy environments. This study characterizes variation in inpatient visiting-hour policies and examines to what extent hospital-level financial characteristics, payer mix, and rurality are associated with policy restrictiveness in four states. Cross-sectional observational analysis of hospital visitor policies in four states (Massachusetts, Wisconsin, Tennessee, and South Carolina) selected based on Medicaid expansion status, population size, and hospital density. A total of 318 acute care hospitals were included using publicly available data from the Centers for Medicare and Medicaid Services and the National Academy for State Health Policy. The primary outcome was total daily visiting hours among general inpatient wards. Assessed variables included volume/capacity, patient mix, financial performance/efficiency, geography, and organizational structure. Hospital-level characteristics including higher Medicaid payer mix, stronger financial margins, greater inpatient occupancy, and larger size were associated with shorter visiting hours in unadjusted analyses. Commercial payer mix and rurality predicted longer hours. Mean visiting duration was 14.1 h/day (SD = 5.07; range 0-24), with Massachusetts having the shortest on average across states (10.5 h/day) and Wisconsin the longest (16.3 h/day). Medicaid payer mix was the only predictor associated with visiting-hour restrictiveness after multiple-testing correction. Each 10-percentage-point increase in Medicaid payer mix was associated with an approximately 11.2% decrease (p = 0.034) in visiting hours. Within-state variation exceeded the differences between-states. Visitation hours vary between the four states, with correlations around rurality of the community served, size of the hospital, and the number of patients on Medicaid. Medicaid payer mix emerged as the most consistent predictor of restrictiveness after adjustment. Hospitals can use those findings to evaluate visitation practices to balance patient-centered care with operational demands.