Patient Discharge Rights

When a patient is being discharged, often times social workers serving as discharge case officers tell the physician that their patient no longer meets Medicare criteria for remaining in the hospital.  What this really means is that the patient no longer qualifies for part A benefits and should be discharged into an appropriate lesser or step down facility such as a nursing home or rehab center or simply home.

But the patient has a right for the local quality assurance organization to review the discharge decision by the social worker talking to the MD.

Discharges often happen on days preceding major holidays such as Labor Day, a religious holiday, or Thanksgiving etc., or even an upcoming weekend because the MD or DO does not want to provide patient coverage on weekends.

There are standards which apply when a patient appeals a discharge decision.  By law the case manager or discharge officer is supposed to assist the patient in contesting a discharge the family thinks is premature and, on the other hand, the discharge officer works for the hospital and may feeling pressured to discharge the patient to please the physician or to protect the hospitals bottom line.

Discharge decisions for Medicare patients should be made using Medicare standards for part A admission criteria.  But many hospitals, such as Tenant, have developed their own discharge criteria.  Medicare part A medical policy supersedes  the "private" medical Policy developed by Tenant, for example.

Sometimes hospitals forget when reviewing a patient's medical chart, that records must be evaluated according to Medicare part A standards and not the standards set by for profit or some not for profit hospitals.

All hospitals really have five types of patients:  Commercial patient pay, private insurance, Federal Medicare, Medicaid and so Affordable Care Act (Obama Care) patients.

Each of these patients have a legal right to have their discharge decisions decided by the appropriate discharge standards.

Hospital medical directors need reminding of the type of patient they are reviewing a contested discharge.

Discharging a patient too early can have serious financial consequences for the hospital by way of penalties and fines.

Hospital social workers and nurses acting as discharge planners need to be very aware of which standards to apply before discharging them.

Family members contesting a discharge should remember to ask the hospital staff which medical policy they used when making discharge or observation status decisions.

Jonathan Schuman
Fla. Bar Health Law subcommittee
AHLA member