How to Fight a Hospital Discharge

About the only aspect of leaving a hospital that is consistent among all patients is that we all do it sooner or later. Hospital discharge is the process by which you prepare to leave the hospital.

In an ideal world, hospital discharge would take place when both you and your healthcare provider think the time is right. You would be strong enough and healthy enough to handle not only the important discharge tasks and details, but also to take care of yourself once you arrive at your destination.

However, we don’t live in an ideal world. In order to understand why problems arise with the timing of hospital discharge, and what can be done about it, we need to understand how the decision is made about the amount of time you’ll be hospitalized.

Why Discharge Is Your Payer’s Decision

Before you are admitted to the hospital, your entire hospitalization and any predicted tests, procedures, and treatments must be approved for payment by your payer—an insurance company or a public payer such as Medicare, Tricare, the VA, or state Medicaid payer.

To determine what they will pay for, payers rely on diagnostic codes, called ICD codes, and procedure (service) codes called CPT codes to describe what is wrong with you, and therefore what treatment or tests need to be performed to help you.

Included in those descriptions are the average amount of time you are approved to be in the hospital to complete the tasks that fall under those codes.

What “average” means is based on the insurance company's opinion on what the ideal patient, someone with no additional problems, would need. It’s not at all based on individual patients and their status.

Therefore, your date and time of discharge are not based on physical readiness. They are based on coded payments which may be in direct conflict with your readiness.

When Patients Should Stay Longer

Problems will crop up if you aren’t “average.” Maybe your body is having trouble healing from surgery. It’s possible you’ve gotten a hospital infection, or have been the victim of a drug error. Older people take longer to get back on their feet.

For these reasons and others, you or your healthcare provider may determine that the payer allotted time won’t be enough time for you.

If there has been an additional problem (like the infection or a drug error), the hospital may automatically try to extend payment for your stay, and you won’t ever hear about it. But that does not always happen.

So you may be caught in a bind. What is wrong with you—based on your diagnostic code—may mean they’ll pay for only two days. But if you are discharged in two days, you may be stuck with the cost of the other facility—possibly for months or years.

Other Reasons You May Want to Stay

It’s also possible your reluctance to leave isn’t based on your health status at all; rather it’s about the lack of caregiving support you have at home or fear that something major could happen and go unnoticed without 24/7 monitoring.

Maybe you are just lonely and you like the attention you get in the hospital. The truth is, in most cases, these are not good enough reasons to stay.

Hospitals can be dangerous places. Only the sickest of patients are found in hospitals, and along with them are found the worst of infectious agents which are too easy to contract.

Infections also rear their very ugly heads when the hospital personnel who care for you—healthcare providers, nurses, and others—don’t work diligently to stop their spread, which they can do by washing their hands and taking other steps to keep you safe.

Further, we know that hundreds of thousands of Americans die in hospitals every year, not from the reason they were hospitalized to begin with, rather because something that happened during their hospital stay killed them.

Staying Longer May Cost You More

As you consider filing an appeal, don’t forget that staying longer may cost you out of your pocket more, too. You may have co-pays, deductibles, and co-insurance you’ll owe to the hospital for the extension.

How to Appeal a Discharge

Once you’ve been given a discharge date and you and your healthcare provider agree that you should extend your stay, you will want to appeal (fight) the discharge date you’ve been given.

The steps for appealing the discharge date will vary from hospital to hospital, and from state to state unless you are a Medicare patient. Medicare has a very specific process to follow no matter where you live or what hospital you’ve been admitted to.

Those guidelines may also be used by the hospital for non-Medicare patients, so if you decide to appeal and you aren’t a Medicare patient, you can attempt to try to follow their instructions anyway.

Here are some generalities that may be helpful to you no matter who your payer is:

• Read the notice of discharge. Your hospital admittance should include a statement of your rights along with discharge information and how to appeal a discharge. If you aren’t provided with a notice of discharge and how to file an appeal, request one from the hospital's patient advocate and follow those guidelines.
• Talk to the QIO. The person you will be appealing to is called the Quality Information Officer (QIO). The federal government has strict requirements for the way a QIO handles discharge appeals.
• Ask about the "Safe Discharge" policy. Safe discharge is the key term Medicare uses, and you can use it, too. In your appeal, state that you don’t believe the current plan meets the needs of safe discharge as defined by Medicare. Even if you are not a Medicare patient, using the terminology may sway the decision in your favor.

The Hospital May Help Fight

Keeping in mind that hospitals only make money when their beds are full, there will be circumstances when they want to go to bat for you to help keep you there. Of course, the longer you stay, the more money they make. Therefore, you may be able to depend on them to convince your payer to keep you there.

In addition, the Affordable Care Act's Hospital Readmission and Reduction Program (HRRP) applies financial penalties to hospitals that have too many readmissions of Medicare patients. Hospitals are now under scrutiny for discharging patients too soon.

Whatever you decide, be sure it's in the best interest of your health and medical status and that the stress of the process doesn't have a negative effect on you.