Why Do They Make You Leave the Hospital With Little Notice?
Sometimes people are on a search for assisted living, home health care, skilled nursing or a nursing home because they’re pressed for time by the hospital. The hospital may have said that your loved one is being discharged the next day, you’ve received a list of possible facilities for rehab, and now you have to pick one. But why on earth do they make you leave so soon, and with so little notice?
The truth is that hospitals are discharging patients quicker now than they ever have before. By comparison, in 1969, those patients 65 and above stayed in the hospital an average of 14.2 days. In 1982, that was cut down to 10.1 days, and now it’s only 6.4 days. But why? The answer to this is that Medicare is under constant pressure from Congress to cut spending and expenses. Now, benefits from Medicare pay a hospital the same fixed fee for everyone who has a particular medical condition—even if one’s condition is more severe than another. If a patient stays too long, the hospital must pay the extra costs out of its own pocket. However, the shorter stay a patient has, the more money the hospital gets to keep.
So just how bad is this issue? The Wall Street Journal found that “Nearly one in five people admitted to the hospital with broken hips are discharged before all of their vital signs are stable. Those patients are far more likely to die or be readmitted to the hospital within two months.”
To help alleviate the situation, Medicare guarantees you certain rights if you think you’re being asked to leave too soon. However, you get these rights along with all the other papers you have to sign in the hospital when you’re admitted, so they can often get lost amid everything else. This means that most people never realize just how important those documents are.
But you have a few options if you feel like you’re going to be discharged too soon. Let’s take a look at them below:
Option #1 – Immediately ask for a written explanation by a hospital representative, if you haven’t already got one. It is known as a “Notice of Noncoverage.” It will also let you know if your doctor or hospital’s Peer Review Organization (PRO) agrees with the hospital’s decision.
You should receive the notice at least 3 calendar days prior to the discharge date. Even if you don’t want to appeal the decision, the hospital can’t charge you for the cost of your stay during those three days. If you have not received the notice, the three-day clock doesn’t start until you do receive that notice.
Option #2 – If you want to appeal and the doctor agrees with the hospital, you have to ask the hospital’s PRO to review the discharge decision. You may contact them by writing or by phone. (The notice will include the PRO’s address and phone number.) However, you have to make your request before noon of the first work day after you get the notice.
If the PRO agrees with the notice, you might be billed for the costs of your care you got starting at noon of the day after you receive the PRO’s decision. You will not be charged for the hospital care from the time you make your request until you receive the PRO’s decision even if it agrees with the hospital. If the PRO disagrees, though, Medicare will continue to pay for your hospital care.
Option #3 – If you doctor disagrees with the hospital, the hospital could ask the PRO to review your case. If the PRO agrees with the hospital, and you still think you’re getting discharged too soon, you can ask them to reconsider the decision. You have to make the request by phone or in writing to the PRO immediately upon getting the notice.
The PRO may take up to 3 working days to complete the review. It will tell you in writing of its decision. Because of this, your hospital is allowed to start billing you for your care starting with the 3rd calendar day after you get the Notice, even if the PRO has not completed its review. If the PRO keeps agreeing with the hospital, you may have to pay for at least one day of hospital care.