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Sicker Quicker Hospital Discharge a Bad Idea

First, I want to thank everyone who helped get the word out on our recently-orphaned therapy dog, Annabelle.  I am happy to report that Annabelle has found a new, adoptive home and that dog and master are doing great.  Thank you for making our internet community work.  Now, shifting gears…

Hospitalization seems to figure prominently in most of the new clients we see.  It is either a recent trip to the hospital that triggers the call to a care manager, or it also can be a surprise discharge from the hospital that sets everything in motion.  You may ask, why should a discharge be the urgent situation?  Well, the practical side of health care as we know it these days revolves around a big push to discharge patients “sicker quicker.”  It can happen with the nurse or an aide walking into the hospital room and simply announcing to the patient and whomever is at their bed side that it is time to leave…often for a nursing home.

Most patients and their families will scramble to comply.  Nobody really wants to be hospitalized, but how prepared is the patient or the family for a return home or a quick departure for the nursing home?  The fact is you need to know your rights.  A family in this circumstance can file what is called  a “fast appeal” of a pending discharge with a Medicare Quality Improvement Organization. Make that telephone call on the spot, and the patient can  stay in the hospital until an independent physician reviewed the circumstances. Every 65+ year old adult admitted to a hospital as an inpatient has the right to challenge a discharge if he or she feels unprepared to leave. But few people understand the process that’s involved.

In fact, all Medicare patients upon admission should receive a written notice of their rights.  It will be labeled: “Important Message from Medicare” and in it you will be supplied with the name and a phone number for your Medicare Quality Improvement Organization (QIO).  These are the people who handle fast appeals and other quality of care issues.  Once you make a call, you or your loved one may be asked to fill out a form that allows the QIO to act on their behalf. Once that fast appeal has been filed, the hospital cannot transfer the patient.  But you don’t necessarily have to be surprised.  Ask on a daily basis what the expected departure date may be.

Now, there is fast and there is really fast.  Make sure that if a patient is to be discharged under the 24 hour mark, the stay may not be considered an inpatient hospitalization.  It may simply be labeled as “observation” and therefore may not be covered as a hospital stay.  Make certain of your rights here so that you are not billed inappropriately.  Make sure that your primary care physician and possible also a care manager are in the loop so that you will have an advocate.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  Please email your questions to


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