In most cases, healthcare professionals and patients agree on when it is time to discharge from the hospital. However, there are circumstances in which disagreements may arise.
In cases where the patient decides to leave against the advice of the doctor, the case will be marked as a discharge "against the advice of the doctor" (AMA). The AMA designation is used in part to help legally protect a healthcare provider and hospital from liability if a patient becomes ill or dies as a result of premature discharge.
Why Hospitals Want Patients To Stay
Patients sometimes remain suspicious that hospitals are a money-making scheme, the purpose of which is to keep them under surveillance and run as many tests as possible to increase their bills. However, the reasons are often in patient safety.
The Hospital Readmission Reduction Program (HRRP) under the Affordable Care Act imposes penalties on hospitals if Medicare patients are readmitted within 30 days of discharge. It was designed to ensure that patients are not discharged until they have recovered sufficiently to return home and complete their recovery.
In some cases, more serious ethical and legal issues can arise that will cause a healthcare provider to keep patients under surveillance for longer than necessary, especially in an era where medical malpractice is rampant. Still, there is no evidence of widespread practice, especially regarding AMA discharges.
Most of the evidence suggests that AMA discharges are announced solely for medical reasons, and that patients who are discharged prematurely are at increased risk of readmission and even death .
If anything, healthcare providers appear controversial and largely uninformed about the AMA's discharge announcement.
According to a University of Chicago study, 44% of physicians and 67% of residents mistakenly believed that being discharged from an AMA hospital was causing their patients to default on their health insurance and holding them fully responsible for your medical expenses. In fact, there were no cases of denial of payment due to abandonment of the AMA by a patient.
In the United States, the total number of patients discharged with AMA increased 41% between 1997 and 2011. Even more surprising, the number of Medicare patients who were discharged with the AMA increased from 25% to 29% between 1997 and 2011.
Before you decide to leave the AMA
Leaving an AMA hospital is not an easy decision. One of the most common reasons people do this is because of cost. For example, if you have high deductible health insurance or pay cash, every day in the hospital can lead to an increase in medical bills that are difficult for you to pay.
Solving payment problems
While the high cost of hospital care can be a concern, many patients will choose to leave without first meeting with a hospital attorney, patient representative, or ombudsman to review actual billing and discuss ways to cover or subsidize costs. costs. …
You can request a reduction or even forgiveness of your bill from the billing department if you provide proof of financial end. Most hospitals also offer a 0% payment plan. If all else fails, you can apply for a credit card with a 0% starting annual interest rate on purchases.
Consideration of legitimate complaints
If you decide to leave because you are not receiving adequate care, do not agree with your treatment, or find errors or mistakes that could endanger your health, do not do so without first filing a formal complaint with the hospital administrator.
Hospitals do not take SREs lightly given their legal obligations. They usually take quick action to correct the mistake or come up with a decision (including transferring you to another hospital).
Until a satisfactory solution is reached, avoid signing any document that exempts the hospital from SRE responsibility and insist that a patient advocate be available to assist in mediation.
If the proposed solution incurs additional medical costs, insist that the hospital cover these costs. If your complaint is substantiated and requires action, they are more likely to make a decision.
Weighing the pros and cons
On the other hand, if you are leaving due to bad experiences in the past, fear of hospitals, or fear of methicillin-resistant Staphylococcus aureus (MRSA ) or other potential risks, it is important to speak with your healthcare provider. and be open-minded when discussing your concerns.
Ultimately, you need to be as objective as possible so that you can weigh the benefits and consequences of leaving with the benefits and consequences of staying.
If you have health problems and cannot make an informed decision, find a family member, trusted friend, or private patient representative to protect you on your behalf. Contact the National Endowment for Patient Advocacy at 800-532-5274 for help with referrals.
If you decide to leave the AMA
There are a few things to keep in mind when deciding whether to prescribe an AMA:
- If you want to leave, chances are you can . The only exception would be mental health patients, for whom discharge may put themselves or others at risk of harm.
- AMA statements do not override the terms of your insurance . This will not result in denial of payments or a premium increase. However, be aware that you will incur additional medical costs if you are readmitted as a result of an early discharge.
- You will be asked to sign the registration documents . This document is not associated with any SRE complaints you may have filed. The statement indicates that she decided to leave against her doctor's advice. Have an attorney on hand to review the document and help you understand the conditions.
- No need to sign papers . You have the legal right to travel and there is no law that requires you to sign your registration documents. With that said, you should prepare a letter that explains why you decided to leave. Keep a copy of the letter and give it to the hospital administrator.
Get the word of drug information
You have every right to accept or refuse any treatment offered to you, but never do so to the detriment of your health. In either case, try to resolve problems if you can and never interfere with treatment or recovery due to an argument or disagreement.
After all, the best way to avoid hasty decisions is to never make decisions alone. Having a friend or family member close by can help you overcome emotions, conflicts, or even medications that can affect your judgment.
If you decide to leave, ask your loved one to stay with you in the event of an emergency and do not interrupt communication with your doctor or hospital if you have questions, concerns, or concerns of any kind.
Frequently asked questions
You will be asked to sign discharge documents stating that you are going against your doctor's advice. You are not required by law to sign them, but refusing to do so does not necessarily mean that the hospital is legally responsible for you if you become ill due to an early discharge.
In most of the cases, no. However, if a person has a mental illness or disability, the hospital can take legal action to avoid discharge against the doctor's advice. Minors and persons under the legal guardianship of others cannot resign; only their legal guardians.
If you are discharged against medical advice, you may be in breach of your insurance policy and be denied coverage, denied payments, or charged higher premiums. More importantly, you can put your health at risk if you don't fully recover from a cured condition.