Fact & Fiction for AMA Patients

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Short power point on what to do when hospitalized patients leave AMA (Against Medical Advice)

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Fact & Fiction for AMA Patients

  1. 1. Financial Responsibility of  Hospitalized Patients Who Left Against Medical Advice:   Medical Urban Legend? Gabrielle Schaefer, MS2, Heidi Matus, MD, Dr. John Schumann, Dr. Vineet Arora
  2. 2. Patients Leaving AMA <ul><li>1-2% of all discharges </li></ul><ul><ul><li>500,000 annually </li></ul></ul><ul><ul><li>Young (relatively), Male, Medicaid, uninsured, urban hospitals </li></ul></ul><ul><li>At risk for worse outcome </li></ul>Southern W, 2010 Ibrahim, SA., Kwoh, CK., & Krishnan, E. (2007). Factors associated with patients who leave acute-care hospitals against medical advice.. American Jounral of Public Health , 97 (12), 2204-8. Southern, W., Nahvi, S., & Arnsten, J. (2010). Increased mortality and readmission among patients discharged against medical advice. Society of Hospital Medicine Annual Meeting , 1 , 72-3.
  3. 3. Financial Responsibility when Patients Leave AMA 4 <ul><li>Commonly held notion that insurance will not pay when patients leave AMA </li></ul><ul><ul><li>Recent study in Northshore ED </li></ul></ul><ul><ul><ul><li>100% (n=104) AMA patients fully reimbursed (Widger HN, 2010) </li></ul></ul></ul>Widger, HN., Propp, DA., Leslie, K., & Mathew, A. (2010). Insurance companies refusing payment for. Annals of Emergency Medicine , 55 (4), 393.
  4. 4. <ul><li>Educate physicians and other health care workers </li></ul><ul><li>Give doctors other strategies or a protocol for handling patients that want to leave AMA </li></ul><ul><li>Remove misleading statements from forms </li></ul>What Hospitals Can Do
  5. 5. What Doctors Can Do <ul><li>Meet with patient and hear their concerns </li></ul><ul><li>Try to compromise on a treatment plan or address their concerns </li></ul><ul><li>Asses decision-making capacity and document assessment </li></ul>Hertz, BT. (2010, March). Act quickly and listen a lot what to do when a patient wants to leave ama. American College of Physicians, Hospitalist , March 2010 , Retrieved from http://www.acphospitalist.org/archives/2010/03/against.htm Hwang, SW. (2005, May). Discharge Against Medical Advice, Commentary. AHRQ, Morbidity and Mortality Rounds on the Web, http://www.webmm.ahrq.gov/case.aspx?caseID=96
  6. 6. When Patients Insist On Leaving <ul><li>Communication </li></ul><ul><ul><li>Written summary of diagnoses, treatments, meds </li></ul></ul><ul><ul><li>Contact primary care provider if possible </li></ul></ul>Hwang, SW. (2005, May). Discharge Against Medical Advice, Commentary. AHRQ, Morbidity and Mortality Rounds on the Web, http://www.webmm.ahrq.gov/case.aspx?caseID=96 <ul><li>Arrange follow up </li></ul><ul><ul><li>circumstances under which they should return immediately </li></ul></ul><ul><ul><li>medications </li></ul></ul><ul><ul><li>out-patient appointment </li></ul></ul>

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