How to fight a hospital that wants to discharge you early

Problems arise if you aren’t the “average” patient and are not ready to be discharged. If you are discharged too early, you may experience exacerbating complications at home or need to be readmitted to the hospital.

Reasons you may need to stay longer

• Your post-operative recovery is not progressing as anticipated.

• You've developed a hospital-acquired infection or experienced other surgical complications.

• An error has occurred in medication administration, resulting in a drug reaction or complications from anesthesia.

• Due to advanced age or frailty, it is unsafe for you to be discharged home.

• There is a need for transfer to a skilled nursing facility or rehabilitation center, but Medicare eligibility requires a minimum three-day hospitalization.

• The initial diagnosis code was inaccurate, and you require a higher level of care than initially indicated.

In such instances, your healthcare provider has the capability to communicate directly with your insurance provider, supplying the necessary information to secure approval for an extension of your treatment or any additional necessary procedures. Occasionally, the hospital may independently assess the situation, particularly in the event of postoperative complications, and obtain approval from your insurance provider without requiring your direct involvement or awareness.

Reasons you may be denied

Your hesitance to leave may not solely stem from your health condition; it could also be attributed to the lack of caregiving support at home or concerns about potential unnoticed emergencies without round-the-clock monitoring.

Alternatively, you might simply feel lonely and value the attention received in the hospital. However, in most instances, these reasons alone may not justify an extended stay.

The procedures for initiating an appeal will vary depending on the hospital and state regulations. (An exception is Medicare, which follows a standardized process regardless of location or hospital.)

To start the appeals process:

• Familiarize yourself with hospital protocols: Your admission documents should contain a statement outlining your rights, discharge procedures, and steps for appealing a discharge. If this information is not provided, you can request it from the hospital's patient advocate.

• Consult the Quality Information Officer (QIO): Responsible for overseeing appeals, the QIO is a hospital staff member designated for this purpose. Federal regulations dictate the process for discharge appeals handled by the QIO, with decisions typically rendered within 24 hours of submission.

• Understand your entitlements: In many cases, you have the right to appeal on the day of discharge and remain in the hospital until noon of the following day after the QIO has been notified. The hospital cannot compel you to leave before a decision is made.

• Collaborate with your healthcare provider: Your surgeon or primary healthcare provider can provide the necessary documentation supporting the medical necessity of an extended hospital stay.

• Inquire about the "Safe Discharge" policy: This policy ensures that patients have appropriate care and support arranged post-discharge. Strict criteria govern the determination of a safe discharge, which can be communicated to your insurance provider for clarification.

Learn more here: How Medicaid Prevents Hospital Readmissions

What to do when you suspect a hospital is discharging you early

Regardless of the circumstances, you might find yourself in a position where you need to contest the decisions made by the hospital administration. One avenue to pursue is through the hospital's "Safe Discharge" policy, which holds significance, especially concerning Medicare regulations. Hospitals that discharge patients prematurely risk financial penalties if the patient requires readmission shortly thereafter.

Under the Hospital Readmission Reduction Program (HRRP) established by the Affordable Care Act, hospitals may face penalties for high rates of readmission among Medicaid patients. Excessive readmissions, defined as returning to the same hospital or seeking emergency care within 30 days of discharge, can trigger these penalties.

To date, the HRPP ruling applies to only the following medical conditions, although more are being proposed:

• Acute mocardial infarction (heart attack)

• Chronic obstructive pulmonary disease (COPD)

• Heart failure

• Pneumonia

• Coronary artery bypass graft (CABG) surgery

• Elective primary total hip arthroplasty (hip replacement)

• Elective primary total knee arthroplasty (knee replacement)

While the same regulation doesn't extend to patients outside of the Medicare system, it doesn't imply that you're without recourse if the hospital insists on your departure. There are steps you can take independently or with the assistance of a patient advocate to challenge this decision.

If you believe you're being discharged prematurely, you retain the right to appeal. Although the appeals process may vary, ultimately, you'll require a healthcare provider to justify the necessity of an extended hospital stay. A Quality Information Officer or a similar hospital staff member would then submit the appeal to your insurer, with a response typically expected within 24 hours.

You have the option to initiate the appeal on the day of discharge, and typically, you won't be held financially liable for any additional charges until noon the following day. Beyond that point, you may become responsible for associated expenses.

Learn more here: How to Fight a Hospital Discharge

To understand how common this issue is, review the results from the National Hospital Discharge Survey.