Variation in Hospital Visiting Hour Policies in US Acute Care Facilities: An Exploratory Cross-Sectional Analysis

BackgroundHospital visiting-hour policies vary widely across the United States, yet the structural factors shaping this variation remain poorly characterized. ObjectiveThis study investigates how hospital-level financial characteristics, payer mix, and rurality relate to the restrictiveness of inpatient visiting-hour policies, and assesses whether these relationships differ across states with diverse Medicaid expansion statuses. DesignCross-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. ParticipantsA total of 318 acute-care hospitals were included using publicly available data from the Centers for Medicare & Medicaid Services and the National Academy for State Health Policy. Main MeasuresThe primary outcome was total daily visiting hours in general inpatient wards. Predictors included volume/capacity, patient mix, financial performance/efficiency, geography and organizational structure. Key ResultsHospital-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 hours/day (SD = 5.07; range 0-24), with Massachusetts having the shortest on average across states (10.5 hours/day) and Wisconsin the longest (16.3 hours/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 11.3% decrease (p = 0.002) in visiting hours. Within-state variation exceeded the differences between-states. ConclusionsVisitation hours vary considerably, 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 these findings to evaluate visitation practices to balance patient-centered care with operational demands.