Being discharged from the hospital can be a confusing and stressful time. Patients are often eager to go home, but may feel unprepared for the transition. It’s important for patients and families to understand their legal rights regarding hospital discharge. This guide provides an overview of key laws and regulations in the United States that impact the discharge process.
Introduction
Hospital discharge is the process of ending inpatient care and transitioning a patient to the outpatient setting. It involves both medical and administrative components, including confirming the patient is medically stable, providing discharge instructions, coordinating follow-up care, and handling insurance and billing details.
Several federal laws exist to protect patients during hospital discharge. These laws aim to ensure discharges are conducted properly and that patients’ rights are respected. Understanding these regulations can help patients advocate for themselves and work collaboratively with hospital staff for a safe, effective discharge.
EMTALA
The Emergency Medical Treatment and Labor Act (EMTALA) passed in 1986 protects access to emergency care and hospital transfers. Under EMTALA, hospitals are required to medically screen all patients who come to the emergency room requesting examination or treatment. They must stabilize emergency medical conditions before discharging or transferring patients.
EMTALA applies not just to emergency room visits, but also hospital inpatient admissions through the emergency room. Hospitals cannot discharge unstable patients who accessed care through the ER without offering stabilizing treatment.
Notice of Non-Coverage
Medicare patients have the right to receive a Notice of Non-Coverage from the hospital indicating when Medicare will no longer pay for inpatient care. This notice must be delivered at least two days before discharge so the patient has time to appeal the decision if desired.
If the hospital does not provide adequate notice, financial penalties may be imposed. Delivering a timely Notice of Non-Coverage protects the hospital from these penalties. Patients should review the notice and understand when their benefits end before signing.
Discharge Planning Requirements
Hospitals that accept Medicare must have a discharge planning process that applies to all inpatients, not just those with Medicare. Discharge planning must begin soon after admission and involve the medical team identifying the patient’s post-hospital needs.
Federal law requires that discharge planning include:
- Evaluating the patient’s likely care needs after hospitalization.
- Discussion with the patient or family members to develop the discharge plan.
- Helping the patient select a post-acute care provider like a rehab facility.
- Educating the patient about their care after discharge.
- Assessing if the patient will need medical equipment at home.
Documenting the discharge plan in the patient’s medical record is also legally required.
Patient’s Right to Appeal
Patients have the right to appeal their discharge if they feel it is premature or unsafe. The patient must sign an Against Medical Advice (AMA) form acknowledging discharge is against medical recommendations.
With the AMA form signed, the financial responsibility shifts to the patient. However, signing an AMA form does not mean the patient forfeits the right to contest an inappropriate discharge. Patients can still file complaints through hospital administration or regulatory agencies if discharge laws were violated.
The Discharge Process
The discharge process typically involves several steps, many of which legal standards and regulations govern. Key components of a lawful, patient-centered discharge include:
Discharge Decision
The physician responsible for the patient’s care makes the official discharge decision and communicates it to the patient. Federal law prohibits discharging patients to an unsafe setting, so the physician must verify the patient is stable enough to transition to outpatient care.
Discharge Summary
The physician must place a discharge summary in the medical record outlining the patient’s care, condition at discharge, and follow-up needs. This documentation is critical for informing the care team during transitions.
Patient Education
Nurses or care coordinators provide discharge instructions covering medication needs, follow-up appointments, warning signs to monitor, and who to contact with questions. Teach-backs help ensure patients comprehend key information.
Care Coordination
Social workers or case managers coordinate details for follow-up services like home health or durable medical equipment delivery. Clear hand-offs are made to outpatient providers through records transfer and communication.
Administration and Billing
The hospital’s administrative staff review insurance coverage, obtain preauthorizations for post-acute services if needed, and provide information on hospital bills.
Conclusion
An intricate process, hospital discharge requires collaboration between providers, staff, and patients to be properly conducted. Several federal regulations exist to protect patients during this vulnerable transition period. Hospital discharge laws can empower patients to actively participate in their care when informed about them. However, patients may need to further advocate to enforce these laws if hospital staff do not follow appropriate procedures. With a comprehensive understanding of their legal rights, patients can work constructively with hospitals to ensure a safe and orderly discharge.
