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Toby Laping Associates www.WNYCareManager.com
Eldercare News |
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You Need To Know . . . When the Hospital Wants You to Leave by Toby F. Laping, Ph.D., C.S.W. So you were put in the hospital because you fell. Two days later, you had a visit from the discharge planner who wanted to know where you were going when you left the hospital. All you could think of was how awful you feel; how outrageous that the hospital allowed such an intrusion when all of your energy was focused on feeling better. Sound familiar? It probably does if you’ve been in the hospital lately. We know that hospitals are not good places to be. As a patient, you’re at risk of infections which may be acquired, medication errors which may be made, interrupted sleep, etc. Still, sometimes you’re just not ready to think about discharge planning when the hospital wants you to do so. It helps to know your rights so you can make an informed decision about your discharge. Particularly when the patient is older, hospital discharge planners sometimes ask the patient or his family about discharge shortly after admission because the hospital must move people through the system and out of the hospital in a safe, efficient manner. It’s costly for hospitals to keep patients when they could be discharged home or to other facilities; actually, Western New York’s hospital stays are longer than average across the country. Nursing homes increasingly are providing services that used to be provided only in hospitals; that’s why so many people are discharged to nursing home units when most of us would think of those people as still quite ill. Sometimes those patients require “sub acute” care on specialized nursing home units; other times, they are placed on traditional long term care units. For a variety of reasons, patients are sometimes in hospitals longer than the hospital wants them to stay. The hospital utilization review nurse may decide that the patient doesn’t need to be in the hospital any longer and will issue a letter saying that the patient no longer needs acute care. The letter may say that the patient is going on “alternate level of care” status. That letter reinforces the fact that the patient has been determined no longer to need acute care but that does not mean that insurance is being stopped. Often, the patient will go on what’s referred to as “Medicare skilled” status. That means that Medicare will still pay the bill although there’s a new copayment amount. Often, secondary insurances will cover that new co pay. It’s also important to note that Medicare skilled status does not use up any of the potential for 100 days of nursing home Medicare coverage and it does not affect what might be available through Medicare if the patient returns home. Despite what many people feel, alternate level of care status does not mean the patient must leave the hospital that day. You may also receive a letter telling you that it has been determined that your Medicare benefits will no longer pay for your hospital stay. You have a couple of days coverage from the date of that letter but it does mean that shortly, Medicare will cease paying for your stay. It’s quite probable that your secondary insurance will also stop payment. At that point, you should decide whether you want to ask Medicare to review the decision because you feel you are not yet well enough for discharge. Read your letter carefully; it will give you details on how to appeal a decision for no more coverage. It is often appropriate to make that call to request a reconsideration of termination. |