Q.  My husband was recently admitted to the hospital following a stroke. The hospital now wants to discharge him in two days, and I believe he needs to remain longer. What are our rights? We are both on Medicare.

A. Unfortunately, hospitals have a strong financial incentive to discharge Medicare patients as soon as possible. Reason: Medicare pays a predetermined flat rate to the hospital based upon the diagnosis assigned at the time of admission. Thus, if the hospital can discharge a patient sooner, the hospital makes money, and if a patient remains longer, the hospital loses money. However, Medicare patients have rights that can and should be exercised in connection with a hospital discharge:

1) Right to Notice:  Within two days of admission, the hospital must give the Medicare patient a formal notice, entitled “Important Message from Medicare About Your Rights” (“IM”), and another notice just before discharge. This notice explains the patient’s right to receive Medicare covered services, including necessary services he may need after discharge, his right to be involved in any decisions about his hospital stay, and his right to appeal the discharge if he believes it to be too soon.

2) Discharge Planning: Medicare certified hospitals must also help patients arrange care they will need after discharge and provide this information in a written Discharge Plan. This service is usually provided by the hospital’s social worker or discharge planner. However, sometimes the patient must make a specific request to be provided this service. Upon review of the Discharge Plan, the patient has the right to ask for changes. As a part of the plan, the hospital must list nearby home health agencies and nursing homes if those services are indicated, and must assist in arranging placement in another health facility if that is necessary. If a suitable nursing home bed near the patient’s home is not available, he has the right to remain in the hospital, covered by Medicare, until one becomes available.

3) Right to Appeal: Once the patient receives the notice advising of his discharge date, he has a right to appeal. Caution: this right to appeal has a very short time limit and must be exercised by noon of the day before the proposed discharge. There is no exclusion for Saturdays, Sundays or holidays. This right is exercised by telephoning the Quality Improvement Organization (“QIO”) listed on the “Important Message”, and asking for an expedited appeal. For California Medicare patients, the QIO is called Livanta (1-877-758-1123).  Leaving a detailed message is sufficient, but the better practice is to follow that call with a confirming fax (Fax: 1-855-694-2929). Livanta tries to make its appeal decision within a day and will telephone its decision to the patient and the hospital. The patient’s best advocate in supporting the appeal is a letter, or at least written chart notes, from his doctor.

Sometimes initiating an appeal can earn the patient a few more days in the hospital, which can sometimes be critical. Example: a patient must spend three (3) full days in the hospital as an inpatient, before transfer to a nursing home, in order to trigger Medicare’s nursing home coverage (maximum of 100 days).

For more information, visit www.MedicareAdvocacy.org and download a copy of its “Self-Help Packet for Hospital Discharge”, or telephone:  1-860-456-7790.

References:  “Self-Help Packet“, prepared by Medicare Advocacy.Org;   “An Important Message From Medicare About Your Rights” from CMS;  42 CFR 482.43 [“Condition of Participation: Discharge Planning”]; 42 CFR 405.1206 [“Expedited Determination Procedures for Inpatient Hospital Services”]; “Challenging Hospital Discharge Decisions“, By CANHR.