Slowing Down a Hospital Discharge

“Harrowing accounts of elderly people dying alone after being sent home from hospital too soon are related in a report… which says too many vulnerable patients are being failed by the discharge system,” states The Guardian.Slowing Down a Hospital Discharge

Unfortunately, early hospital discharge is not isolated to the United Kingdom — it’s a problem faced in the United States as well.

Slowing Down a Hospital Discharge Requires Fast Action

According to a study by Eric Alper, M.D., “almost 20% [of Medicare patients] who are discharged from a hospital are readmitted within 30 days.”

Readmission rates indicated that at least some Medicare patients are being sent home too soon.

In fact, after the 2008 lawsuit Weichardt v. Leavitt, the American government issued new regulations on the Medicare process of appealing a discharge. Now, almost a decade later, many families and seniors are still unaware of their right to fight a hospital discharge through Medicare’s right to a fast appeal.

What is Medicare’s Fast Appeal?

Many caregivers and seniors are unaware of Medicare’s fast appeal, which states that “you have the right to a fast appeal… if you think your Medicare-covered services are ending too soon.” This includes services you get from:

  • Comprehensive Outpatient Rehabilitation Facility
  • Home Health Agency
  • Hospice
  • Hospital
  • Skilled Nursing Facility

The fast appeals process is run by Medicare’s Quality Improvement Organization (QIO), which also handles quality of care complaints.

Patients who feel they are being discharged too early can call the QIO and appeal, which would allow them to stay in hospital until an independent physician reviews their case and decides either that the discharge is warranted or that the patient should remain in care.

Where to Read the Fine Print During a Hospital Discharge

According to Medicare’s website, whether you’re in a hospital or non-hospital setting, “your provider will give you a written notice before your services end that tells you how to ask for a fast appeal. If you’re not given this notice, ask for it!”

According to the Kaiser Health News, “every older adult admitted to a hospital as an inpatient has the right to challenge a discharge if he or she feels unprepared to leave. But few people understand the process that’s involved.”

The first step is to make sure that you read all the documents provided to you.

“Every older adult admitted to the hospital should get a written notice of their rights — including the right to appeal planned discharges — within two days. If you remain in the hospital for at least five days, you should receive a second notice before being discharged,” Kaiser News states.

If you don’t receive a written notice of your rights then you should ask for one, read it and make sure you understand it.

When to Be Prepared for the Worst

When a loved one is admitted to the hospital, there is a lot of information to digest and manage. Although you hope that the medical team caring for you will do their due diligence, it’s best to be prepared just in case something (like being discharged too soon) happens.

Here’s how to prepare in case of early discharge:

  1. Ensure you receive and read a written notice of your rights
  2. Have your QIO contact on hand in case you need to call them to initiate a fast appeal. The contact information should appear on the written notice of your rights. You can click here to download an example of what a hospital discharge appeal looks like (remember, this form will vary for non-hospital settings).
  3. Remember to also keep the lines of communication open with your doctor — even if that means asking them about your expected length of stay every day. Your doctor should be able to give you an idea of when they are planning the discharge so you’re not surprised.

Generally, if your parent (or yourself) is stable and doesn’t have a fever, serious wounds or trouble breathing, then they are often considered a good candidate for discharge.

When to Appeal a Decision During a Hospital Discharge

There are instances where stable patients should remain in hospital. Liz Barlowe, a care manager from Florida, told Kaiser News about a 78-year-old who fell and injured her hip.

Pre-surgery scans showed the patient had cancer. “After hip surgery, hospital staff said they couldn’t bring in a gynecologic oncologist to consult on the older woman’s case, and recommended that she be sent to a rehabilitation center,” Barolwe said.

After an appeal, “the QIO’s medical reviewer directed that the patient stay there until a cancer specialist provided a consultation and helped to devise a plan of care. The QIO’s intervention bought the family another 48 hours, during which time they were able to find a facility in Miami able to offer chemotherapy as well as rehabilitation for the woman’s hip. And the patient was able to rest and build up her strength,” she stated..

When to Launch a Fast Appeal

Adults in traditional Medicare and managed care-style Medicare Advantage plans can launch a fast appeal by making a phone call to their local QIO office. According to Kaiser News, this process only applies to seniors admitted to hospital and there is a separate appeals process for seniors on observation status.

Generally, QIOs are open 9 a.m. to 5 p.m. Monday-Friday and 11 a.m.-3 p.m. on holidays and weekends. If you call and don’t speak to anyone, then be sure to leave a message stating the date and time of your call.

Then, follow these steps to launch a fast appeal:

  • Contact your local QIO office (the name and number to contact should be on your written notice of rights, called “An Important Message From Medicare About Your Rights”)
    • Tell the QIO you’re filing a fast appeal of a pending discharge
  • In hospital settings you must request a fast appeal no later than the day you’re scheduled to be discharged from the hospital
    • According to Medicare’s website, “if you ask for your appeal within this time frame, you can stay in the hospital while you wait for the QIO’s decision. You won’t have to pay for your stay (except for applicable coinsurance or deductibles)”
  • In non-hospital settings, Medicare advises that you must ask the QIO “for a fast appeal no later than noon of the first day after the day you get the ‘Notice of Medicare Non-Coverage.’ Follow the instructions on the termination notice”
  • Ideally patients should call, but if you’re a caregiver or family member who is calling then you can get the process started, but be prepared to fill out “An Appointment of Representative” form that clarifies that you’re acting as the patient’s representative
  • If you miss the deadline to launch a fast appeal:
    • In hospital settings: You can still ask the QIO to “review your case, but different rules and time frames apply.”
    • In non-hospital settings: “You can request a fast reconsideration from your plan. But, services will only be covered if there’s a decision issued in your favor.”

What to Expect After Launching a Fast Appeal

Once you’ve called the QIO and enacted your right to a fast appeal, several things will happen:

1. You buy yourself some time. You can’t be transferred from the hospital until there is a resolution (which takes approximately two days). Use this time to help find an appropriate plan to care for your parent (or yourself) in case the discharge is upheld.

2. Your medical records will be shared with the QIO and you may request a copy if you wish.

3. Your QIO may reach out to you to talk about your concerns and ask your opinion about the discharge.

4. You receive a speedy decision. In a hospital setting the QIO “will decide if you’re ready to be discharged within one day of getting the requested information.” In a non-hospital setting the QIO “will make a decision by close of business the day after it gets the information it needs to make a decision.”

5. When your QIO decides that your discharge is too soon:

In a hospital setting: “Medicare will continue to cover your hospital stay as long as medically necessary (except for applicable coinsurance or deductibles) if one of these applies:

  • Your plan previously authorized coverage of the inpatient admission
  • Your inpatient admission was for emergency or urgently needed care
  • You may need to appeal the denial of coverage for your plan to pay if:
    • Your plan never authorized the inpatient admission
    • The inpatient admission wasn’t for emergency or urgently needed care”

In a non-hospital setting: “Medicare may continue to cover your CORF, HHA or hospice services (except for applicable coinsurance or deductibles).”

6. When the QIO decides that your discharge is appropriate or your services should end:

In a hospital setting: “You won’t be responsible for paying the hospital charges (except for applicable coinsurance or deductibles) incurred through noon of the day after the BFCC-QIO gives you its decision. If you get any inpatient hospital services after noon of that day, you may have to pay for them.”

In a non-hospital setting: “You won’t be responsible for paying for any CORF, HHA or hospice services provided before the termination date on the ‘Notice of Medicare Non-Coverage.’ If you continue to get services after the coverage end date, you may have to pay for those services.”

Ultimately, it’s up to you as a caregiver, family member or patient to navigate the Medicare system, but it’s good to know that you have the option of a fast appeal should you feel you are being discharged too soon.

Have you ever enacted your right to a fast appeal? What was the result? We’d love to hear your stories in the comments below.

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