Are seniors being discharged from hospitals too early?

Are Seniors Discharged from Hospitals too Quickly?

by Max Gottlieb, Senior Planning

The customer is always right, right?

This is true in most industries, but for some reason, this old adage has taken longer to make it to our hospitals. Today there are websites, like ZocDoc, that provide a way to rate doctors based on bedside manner, overall experience, and wait time. In terms of the hospital setting, though, this accountability simply isn’t there.

Going to the hospital is not an experience most people choose. The hospital can be confusing and stressful enough without having a poor customer experience. We hear accounts of elderly patients who, because they are on Medicare, rather than with a private insurance plan, are discharged from hospitals too quickly. An improper discharge can lead to re-admittance and further complications down the road. So how can customer service improve in the hospital setting? It all boils down to three simple concepts: communication, attention, and proper discharge.

It’s important to separate our frustration with the system from our attitudes towards hospital employees who did not create it, or, have any hand in planning it. Plus, it must be noted that the industry has made strides in recent years. The Affordable Care Act has made Medicare reimbursement contingent on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This 27-question survey asks patients to rate their experiences based on: doctor communication, nurse communication, staff responsiveness, pain management, communication about medicines, discharge information, and care transition. Each hospital receives a rating and the HCAHPS results are publicly reported on the Hospital Compare website four times per year. Tying financial reimbursement to patient satisfaction has pushed customer service to the forefront of hospital priorities.

To understand what’s happening to Medicare patients when they visit the hospital, we must first look at how hospitals are paid when a patient is on Medicare. Medicare, being the primary insurance for many people over 65 years old, makes up a large chunk of a hospital’s income. Medicare is also the determining factor for the type of care and services a senior is eligible to receive. Medicare reimburses hospitals on what is called a “case base.” This means that the hospital is paid a predetermined sum for an entire inpatient episode of a certain type. At a private doctor’s practice, the doctor is still paid a predetermined amount, but the rate is different than if those same tests or procedures were performed in a hospital.

For example, when someone on Medicare breaks a hip, Medicare pays the hospital a set amount for the treatment, regardless of the length of the hospital stay. This can put pressure on hospitals to discharge Medicare patients more quickly than they would in other circumstances. Patients who are discharged too quickly and without the proper information often return.

If you feel you or your loved one is being hurriedly discharged, there is an appeals process to lengthen the stay. Once the appeal is put into motion, a hospital can’t discharge a patient until the appeals board reaches a decision on the claim. For complete directions from Medicare on how to file an appeal, please visit the Medicare website.

The financial weight of the HCAHPS has not solved all of the problems with America’s hospital system, but we are at least headed in the right direction. This is where communication and attention become key. With proper communication, a doctor should be able to make a patient feel like he is being given necessary care without hospital politics getting in the way. No senior should be made to feel that because they are on Medicare they are being given different care than those with private insurance—this is the true purpose of customer service. With the freedom to provide communication, attention and a proper discharge, hospital personnel will be empowered to make a visit to the hospital a more comfortable experience.


Max Gottlieb is the content editor for Senior Planning in Phoenix, Arizona. Senior Planning is a free service for seniors who need help arranging, claiming benefits, and finding the living situation that best fits their needs.