Why do patients leave against medical advice?
ncbi.nlm.nih.gov
Why do patients leave against medical advice?
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Re: Why do patients leave against medical advice?
#2This paragraph caught my eye:
> The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in the hospital upon readmission.
This makes me laugh. As if medical care in the USA isn't already ridiculously inflated.
> Perhaps the most effective way to decrease discharge AMA is through changing existing policies and/or implementing new policies. Historically, governmental policies, incentivizing or penalizing, have dramatically driven substantial changes in the medical system. For example, different healthcare policies/programs have led to improved healthcare access in non-urban areas. Another example is the change of practitioner compensation from traditional fee-for-service models to bundled-payment models that resulted in a better quality of patient experience [51]. Therefore, implementing a lower rate of discharge AMA in hospital metrics, for example, will incentivize hospitals to further invest in mitigating discharge AMA.
We absolutely shouldn't penalize people who leave a for-profit business for not getting the service they desire. Also changing to fee-for-service would help people do a cost-benefit on their medical issues. If we are going to live in a capitalism world, then let hospitals compete for your money.
Re: Why do patients leave against medical advice?
#3I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
Re: Why do patients leave against medical advice?
#4I left AMA once because I was fine but the hospital wanted my perfect insurance in Yuma, Arizona where most of the patients are uninsured immigrants.
I understand that they need to money to survive but three weeks was just outrageous.
Re: Why do patients leave against medical advice?
#5This paragraph caught my eye: > The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in…
Part of my job I build predictive models to identify individuals at high risk of 'readmission' (it impacts billing, hence why healthcare systems are interested).
Conditional on an individual's history (e.g. do you have diabetes, other comorbidities, etc.), I haven't found much evidence that leaving against Dr advisement matters all that much for predicting readmission.
Re: Why do patients leave against medical advice?
#6I left AMA once because I was fine but the hospital wanted my perfect insurance in Yuma, Arizona where most of the patients are uninsured immigrants. I understand that they need to money to survive but three weeks was just outrageous.
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Re: Why do patients leave against medical advice?
#7I've witnessed several people AMA from hospitals.
All of them were not being treated well for pain and even in cases where there were calls for psych staff to help - there was imo below minimal mental / emotional support given.
In a couple of the cases the people were able to find better pain medicine on the street faster than they could even get a doctor to answer a nurses call to deny - and being able to find just one person who would listen or offer any other emotional support was better than what they got paying 10,000$ or whatever it is to stay in a luxurious beeping room.
I'm talking about people with real pain - not a junkie looking for a fix.
I believe these issues have been exasperated since 2019- it appears that most hospital staff is burn out and no longer fit for the job of handling stressed out, hurting people. 2 out of 3 hospitals around here have big signs all over the place stating they have zero tolerance for rude or abusive people.
This policy itself is abused, and it's led to an even worse power dynamic / class war that is making hospitals worse for care, and sending more people to illicit pain management solutions.
small data points. more does not equal all - ymmv.
Re: Why do patients leave against medical advice?
#8This paragraph caught my eye: > The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in…
Part of my job I build predictive models to identify individuals at high risk of 'readmission' (it impacts billing, hence why healthcare systems are interested). Conditional on an individual's history (e.g. do you have diabetes, other comorbidities, etc.), I haven't found much evidence that leaving against Dr advisement matters all that much for predicting readmission.
The number in the GP is conditional on the patient being readmitted, so it's inflated by adverse selection: it doesn't include all the zeros where the patient recovered, but it does include all of the cases where something went wrong and they needed more/different treatment.
Re: Why do patients leave against medical advice?
#9I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
Couldn’t you have enrolled in a plan that would have covered your treatment after the fact? I think you have 30 days to do so after losing coverage. I agree that the current system in the US is insane, but what was your plan originally for when you lost coverage?
Re: Why do patients leave against medical advice?
#10I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
> I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd.
For future reference, asking the hospital what your insurance covers will always result in a "we don't know" answer because they don't speak for your insurance. They can't risk saying "yes" when they aren't the ones deciding.
In these cases, call the insurance company. The reps deal with coverage questions like this all day long.