Introduction to AMA Patients

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. Patients Leaving AMA
1-2% of all
discharges
500,000
annually
Young
(relatively),
Male,
Medicaid,
uninsured,
urban hospitals
At risk for
worse outcome
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. Financial Responsibility when
Patients Leave AMA
Commonly held notion that insurance
will not pay when patients leave AMA
Recent study in Northshore ED
100% (n=104) AMA patients fully
reimbursed (Widger HN, 2010)
Widger, HN., Propp, DA., Leslie, K., & Mathew, A. (2010). Insurance companies refusing payment for. Annals
of Emergency Medicine, 55(4), 393.

4. What Hospitals Can Do
Educate physicians and other health
care workers
Give doctors other strategies for
handling patients that want to leave
AMA
Remove misleading statements from
forms

5. I agree to be fully responsible for any
portion of the hospital bill not covered by
insurance because I left the hospital

6. What Doctors
Can Do
Meet with patient and hear their
concerns
Try to compromise on a treatment
plan
Ask them to sign a form that they are
leaving AMA
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