Tag: Hospital discharge

Coronavirus: What to do before you leave the hospital
In the midst of the coronavirus pandemic, it’s particularly hard to be in the hospital. You want to get out as quickly as possible. But, before you leave, you should be prepared.
1. Understand and decide what will happen after your hospital discharge. Discuss your options with your doctors so that there are no surprises. Make sure all your questions are answered.
2. If at all possible, arrange to be discharged home or to the home of a family member. If that’s not possible, make sure you understand why not. And, see if you can be discharged to a small nursing home. Avoid chain nursing homes.
3. Know who to call and have that person’s number if you have questions after you leave the hospital.
4. Make sure to keep a list of your medications with you at all times. Also, understand whether there are side effects and what to do if you experience them.
5. Know what care is needed to help prevent your condition from getting worse, what symptoms you need to look out for, and who to call if you experience any of them.
6. Schedule follow-up appointments with your doctor–Medicare now covers telehealth.
7. Get a hospital discharge plan. The hospital is required to give you a written plan. If at all possible, have a family member or friend with you—a health care buddy—to help ensure you understand what care you will need after you leave. If you still have questions, review the written discharge plan with your doctor or hospital social worker.
For more information, visit The Care Transitions Program. And, if you haven’t seen these seven tips on how to prepare for a hospital stay, take a look.

Here’s more from Just Care:
May 18, 2020
Seven things to do before you or someone you love leaves the hospital
It’s hard enough to be in the hospital. Most of us can think only of getting out as quickly as possible. But, leaving the hospital can have its own set of risks if you’re not prepared. So, before you or someone you love leaves, here are seven things that you should do:
1. Understand and decide what will happen after discharge. Discuss your options after you leave the hospital with your doctors so that there are no surprises. Make sure all your questions are answered.
2. If you are not going home, make sure you know where you will be going and the reasons for going there, be it a nursing home or a rehab facility or another setting.
3. Know who to call and have that person’s number if you have questions after you leave the hospital.
4. Make a list of your medications, including any new ones, and keep the list on you. Also, understand whether there are side effects and what to do if you experience them.
5. Know what care is needed to help prevent your condition from getting worse, what symptoms you need to look out for, and who to call if you experience any of them.
6. Schedule follow-up appointments with your doctor and arrange for transportation to get there.
7. Get a discharge plan. The hospital is required to give you a written plan. If at all possible, have a family member or friend with you—a health care buddy—to help ensure you understand what care you will need after you leave. If you still have questions, review the written discharge plan with your doctor or hospital social worker.
For more information, visit The Care Transitions Program. And, if you haven’t seen these seven tips on how to prepare for a hospital stay, take a look.

Here’s more from Just Care:
June 24, 2019
What to know about Medicare inpatient hospital care
Medicare Part A covers medically reasonable and necessary inpatient hospital care and discharge planning. Be sure to speak to your doctor to ensure you are formally admitted as an inpatient, since hospitals often classify people with Medicare as outpatients. And, plan ahead, if possible. Be sure to bring along a buddy, a friend or family member who can be your advocate while you are in hospital.

Too often, the hospital treats Medicare patients as outpatients, even if they stay overnight for a few days. Patients are generally unaware of the difference since Medicare Part B covers outpatient hospital care. But, getting outpatient observation care may leave patients with huge health care bills without their knowledge.

People who will need inpatient nursing or rehab care after they leave the hospital particularly want to be sure they are admitted as inpatients. Unless you are admitted as a hospital inpatient for at least three days in the 30 days prior to admission to a skilled nursing facility or rehabilitation facility, Medicare will not cover your care in these facilities.

What does Part A cover? If you are enrolled in traditional Medicare, Medicare Part A covers the full cost of a semi-private room and meals, nursing care, medications and medical supplies for 60 days, after you or your supplemental insurance pays the deductible ($1,340 in 2018). Please note that Medicare Part A does not cover a private nurse, a private room, or any non-medical supplies or services, such as telephones or televisions in your room. Medicare Part B covers your medical services.

Beginning on day 61 up until day 90, if you do not have supplemental insurance–Medigap, retiree coverage or Medicaid–you must pay daily coinsurance ($335 in 2018).

If you are enrolled in a Medicare Advantage plan, check with your plan about your out-of-pocket costs. Each plan differs.

Here’s a list of what you should bring to the hospital. And, to make sure you get the care you need, here’s a list of the seven things you should do before going to the hospital.

Once you are ready to leave the hospital, you are entitled to a hospital discharge plan, laying out where you are going–e.g., home, a nursing facility or a rehabilitation facility–along with the care you will need, who will provide your care, and a list of your medications. If you are returning home, make sure the hospital arranges for home health care, if you will need it, as well as any other services you may need.

The hospital should also let you know which services Medicare covers and which services you will be responsible for paying for once you leave the hospital. Finally, you or your caregiver should be given hospital staff contact information if issues arise after you leave. Click on this Just Care post for a list of the seven things you should be sure to do before leaving the hospital.

Here’s more from Just Care:
March 13, 2018
Pay attention when someone you love leaves the hospital
It’s not something most of us would instinctively believe, but hospitals can be dangerous places and leaving the hospital can be equally or more dangerous. According to the U.S. Agency for Health Care Research and Quality, AHRQ, almost one out of five patients who leave the hospital end up experiencing some harmful effect within 21 days. Yet, most of these events are preventable. So, pay attention when someone you love leaves the hospital.

Here’s Just Care’s checklist of seven things to do before you or someone you love leaves the hospital.

What are the worst things that can happen to a patient upon hospital discharge? The AHRQ’s Patient Safety Network reports that the most serious complication comes from a bad reaction to a new prescription or medical regimen. But, people also often pick up infections from antibiotic resistant bacteria in the hospital. And, some suffer procedural complications. Still others leave the hospital without lab results or with a need for follow-up tests, but do not follow through in a timely way or as warranted.

The risks upon hospital discharge in part stem from a lack of care coordination between the in-hospital doctors and the patients’ primary care doctors and specialists. In addition, there are usually an overwhelming array of directives on discharge from the hospital. Without a “health care buddy,” someone whom you trust at your side as an extra pair of eyes and ears, who can ask questions on your behalf and make sure everything is in order for a safe transfer out of the hospital, there is a high likelihood of mixup.

Keep in mind that it also can be extremely hard for a health care buddy or family member who is not a professional to appreciate the patients’ full range of care needs and how well patients can care for themselves once out of the hospital. Not surprisingly, one in five Medicare patients are rehospitalized in the 30 days after they are discharged.

Here’s more from Just Care:
May 18, 2016
Are hospitals driving up costs for people with Medicare to improve quality ratings?

In a new Health Affairs post, David Himmelstein and Steffie Woolhandler argue that Medicare’s pay-for-performance system might be doing more harm than good, when it comes to hospital readmissions. Hospital readmission rates are not dropping as much as the data might suggest. Rather, they say that while some hospitals have redesigned their systems to improve patient care pre-discharge so that patients do not need to be readmitted soon after, other hospitals have been gaming the system to make it appear so.

Medicare’s new payment incentive system financially penalizes hospitals with high readmission rates. To meet quality standards imposed by the Centers for Medicare and Medicaid services, some hospitals have been reclassifying patient visits within 30 days after discharge so they do not count as readmissions. They either classify patients as outpatients, on “observational” status, or they admit these patients to the emergency room.

As a result, hospital quality improvement is likely not as significant as the Medicare readmission data would suggest. What’s worse, hospitals that fail to “readmit” patients who have been discharged within 30 days may be penalizing those patients financially. Even if they remain on observational status for several days, they will be ineligible for Medicare skilled nursing or rehab services. (To qualify for Medicare skilled nursing or rehab coverage, patients must be admitted to hospital as inpatients for at least three days in the 30 days prior to getting that care.) And, their out-of-pocket costs could be significantly higher while in hospital.

To support their claims, Himmelstein and Woolhandler reveal that hospital outpatient stays increased 96 percent in the seven years between 2006 and 2013. The rise in outpatient stays represents more than half of the decline in reported hospital readmission rates. There has also been a notable increase in hospital emergency department visits.

Hospital charges are already sky high in most areas of the country. And, competition is not reining them in. Some purchasers are using reference pricing to bring them down. Health economist Uwe Reinhardt makes the case for an all-payer payment system.

September 4, 2015
How safe are outpatient surgery centers?

Medicare now covers surgeries in some 5,500 outpatient surgical centers. Patients often like receiving care from these surgical centers because they say they are often more convenient than hospitals, they don’t have to wait as long for treatment and they get more personalized care. And, according to Consumer Reports, about 54 million surgeries are performed each year at these facilities. The question remains are they as safe as hospitals?

Lisa McGiffert, who runs the Safe Patient Project at Consumer Reports questions their safety. Outpatient surgery centers like hospitals are breeding grounds for bacteria that can cause serious infections if the facilities are not kept clean. But, these centers tend not to be as tightly regulated or monitored to the same degree as hospitals. So, it’s not possible to know as much about what’s going on inside them.

In addition, these centers may not have the safety equipment available at a hospital in case of an emergency such as a defibrillator and other lifesaving equipment. Moreover, they may not have staff with the level of training and skills to handle an emergency that are on hand in hospitals.

Before getting care at an outpatient surgery center, do some research. Try to learn about the center’s infection rates. Make sure that the center is accredited, that your surgeon has experience with the procedure you are getting and that your anesthesiologist is board-certified.

Right now, it may be hard to find good data on outpatient surgery centers. We should expect it over time. If you have a serious health condition, you may be better off getting your surgery in a hospital, because they are better equipped to address complications. (You should also choose your doctors carefully.)

We are beginning to see more data rating hospitals, surgeons and doctors on a number of different metrics, including patient safety data from Consumer Reports.

If you get treated in an ambulatory surgical center, be sure you understand what will happen after you leave. Leaving has its own set of risks if you are not prepared.

The Agency for Healthcare Research and Quality is currently funding a 12-month patient safety program in which outpatient surgical centers can participate. And in 2014, Medicare began asking these centers for reports on quality, providing payment increases for those centers that comply.

August 13, 2015
To prevent medical mistakes and delirium, stay on top of care needs when moving from one care facility to another

Medical mistakes in the hospital notoriously happen during changes of shift or because of poor communication among health care staff as they move from one shift to the next. And, when patients move to and from hospital or other health facilities, special care must be taken to assure that prescribed medication continues to be administered as directed, and other health care instructions are properly carried out.

Whether from home or long-term care facility to the hospital or back again, family members or responsible caregivers should bring along medication lists and check these against medicines ordered–even if it’s to the same care facility or nursing home where someone has lived for years. Question any drug changes, and understand why a drug may no longer be listed or why another drug may have been added. Mistakes are made, and often.

You might consider bringing medications along wherever you or the patient you’re caring for goes. An increasing number of medications are special ordered, such as hormones requiring refrigeration or expensive drugs for cancer.

Don’t forget eyeglasses and hearing aids. Of course, in an emergency these may not make the trip to the hospital. But, once hospitalized, these are important for helping to stave off delirium.

Anything one can do to minimize confusion and keep people oriented and tuned into the world around them helps–especially in intensive-care unit settings. Delirium can set in quickly in sick patients. And, for people already with some degree of memory or cognitive impairment, this can seriously complicate recovery and also permanently set back their brain function.

Here’s a checklist to prepare for a hospital stay. And, here’s what to do before you leave the hospital.

July 6, 2015