Most of us dread the thought of being hospitalized. Increasingly, many surgical and diagnostic procedures are being done on an outpatient basis, with the person going home the same day and not requiring admission. For more serious medical and surgical illnesses, the only option is often to be admitted to the hospital.

Common concerns for the inpatient and his/her family are how they will receive information, knowing what information is needed at the time of admission and what rights the patient and family have once admitted. This article briefly describes the admitting procedure and what “rights” the person has to obtain information, protect privacy of the information in the medical chart and how to address concerns about care delivered and the discharge procedure.

The admitting procedure

In addition to being asked to provide insurance information, the patient, if able, will be asked to sign releases of information to the insurance company in order for the medical bill to be paid. Because of national privacy regulations, information can only be given to the parties you indicate. You can also give permission at this time for portions of the medical record to be provided to your primary care physician if your doctor is not caring for you in the hospital.

Additionally, you will be asked to provide instructions on an advanced directive. This document communicates your wishes about your treatment if you are too sick or unable to give consent. You will also be asked to name a healthcare proxy. Many people prepare legal documents that include naming a proxy, power of attorney and a living will in advance, and this is added to your medical chart.

Your healthcare proxy is legally entitled to make all medical decisions if you are incapacitated to do so, including “do not resuscitate” and withdrawal of life support. This person does not have to be a family member. They should know your wishes in advance and be willing to make sometimes very difficult decisions.

After being admitted

The procedure for most hospitals at the time of admission is to give you a booklet that outlines your rights of receiving and sharing information, along with a description of the appeal process that is followed if you or a member of your family disagrees with decisions made concerning your care, billing or discharge. There is contact information for state agencies if you have complaints or wish to appeal decisions made by the hospital or insurance provider. There is usually a “patient’s bill of rights” included.

When in the hospital, do not hesitate to ask questions about the medications you are receiving, the risk of performing diagnostic tests or surgery and any other aspect of care you do not understand.

The payment for your hospital stay is determined by Diagnosis Related Groups (DRGs). The DRG system lists hundreds of reasons why we are admitted and then determines how much the hospital will be paid by your insurance. This is based on the average cost of treating a patient within the same age range, diagnosed with the same or similar condition and needing the same type of treatment. Reimbursement amounts will vary with the diagnosis and with the location of the hospital

Hospitals translate the anticipated payment into anticipated days admitted. This number is only a guideline, because we all recover differently. If you think you are being asked to leave the hospital too soon, you have the right to appeal decisions made by your doctor, hospital staff, insurance company, or your managed care plan. If you feel you have not received adequate instructions on the treatment plan, you can request a delay in being discharged until you get this information. Each hospital, state and insurance carrier has established rapid appeals processes to review this type of complaint.

Other issues

If you have a concern, problem or complaint related to any aspect of care during your hospital stay, first speak to your doctor, nurse, or hospital staff member. If the hospital staff has not resolved the problem, you can contact the state’s department of health by mail or phone. Additionally, you may file a report with that state’s office of professional conduct. This division investigates all reports of possible professional misconduct by licensed medical providers. Written complaints must include the full name and address of the medical provider, along with all relevant information.

All patients have the right to refuse treatment offered in the hospital without penalty of payment. You and your family need to understand the risks and benefits of all aspects of your treatment. If you choose to decline treatment, your doctor will explain what other options are available to you.

If you are hearing or vision impaired, or if English is not your first language, skilled interpreters must be provided to assist you, along with translations and/or transcriptions of important hospital forms and instructions, and information must be provided to you if you feel you need them.

All patients, regardless of insurance type or payment, must receive a written discharge plan before they leave the hospital. This plan should describe the arrangements for any healthcare services you may need after you leave the hospital. The necessary services described in the plan must be arranged or reasonably available before you leave the hospital.