Where to Turn for a Safe and Efficient Hospital Transfer

Navigating a hospital transfer can be difficult, but U.S. News can help. Discover where to turn for safe and efficient transfer services and the best care.

Article By:  Elaine K. Howley and Lisa Esposito

Blog Source From : https://www.usnews.com/

A few years ago, Marcela Flachsland’s family learned her then-77-year-old uncle had advanced pancreatic cancer. Her early impression of the New Jersey acute care hospital where he was a patient was one of confusion and conflicting information from the medical staff. The family felt their uncle’s interests would be better served in a cancer-focused facility.

They sought a second opinion from the nearest branch of a renowned cancer center. A physician told Flachsland’s aunt that they could treat her uncle with chemotherapy. However, doctors at the acute care hospital insisted a transfer would be too difficult for the weakened patient, and that moving him was not a medical necessity.

“As a relative, you want to do everything possible,” Flachsland says. “You’re just trying to find other options. My aunt was devastated and frustrated, and she didn’t know what to do.”

You Can Choose Your Care Location

“The benefit of American health care is that patients are empowered to choose where to receive care – even in an acute event,” says Russell Graney, the New York-based founder and CEO of Aidin, an online platform that helps connect providers, patients and payers to improve health care outcomes.

One hiccup, however, is the general lack of knowledge about this option.

“Patients are often unaware that they can change hospitals – or are told by the staff that it isn’t possible,” says Julia Hallisy, founder and president of the Empowered Patient Coalition, which aims to help people improve the safety and quality of their health care, in San Francisco.

Arthur Caplan, a professor of bioethics and the founding head of the division of medical ethics at the NYU School of Medicine in New York City, agrees. Patients absolutely have the right to transfer to another hospital, he says. However, the burden of getting a second hospital to agree to take the patient falls on the patient or a family member advocating for their loved one.

Advocating for Patients

It’s a “medical urban myth” that leaving a hospital against medical advice will get a patient into trouble with insurers and billing, says Dr. David Alfandre, a physician and health care ethicist and associate professor in the departments of medicine and population health at NYU Grossman School of Medicine in New York City. Alfarndre has done extensive research on AMA (against medical advice) discharges. He says physicians shouldn’t exaggerate AMA consequences to discourage patients from leaving.

“While practicalities like distance, insurance coverage and the hospital’s ability to provide the necessary care govern most decisions, if a patient or family feels their loved one isn’t receiving the care they need, it’s essential to speak up, advocate for yourself and, if necessary, transition your care to another team,” Graney explains.

Flachsland’s uncle had the right to leave the hospital at any time – at least in theory. But he was frail, ailing and in pain. If he were transferred, insurance complications meant his wife would have to pay ambulance and other transfer costs.

Difficult situations like what Flachsland described crop up now and again for families across the country, and these experiences are nearly always emotionally fraught and usually urgent. Such situations tend to arise when the relationship between patient and provider has been damaged in some way.

Factors Behind Hospital Transfers

Concerns about quality of care aren’t the only reason you or a loved one might seek to switch hospitals. There are a host of reasons why changing hospitals might be a good idea, from simple geographic location to needing to see a specialist who isn’t affiliated with the hospital where the patient is currently admitted.

Most hospital transfers occur at a physician’s request, says Dr. Naeem Ali, medical director of the Ohio State University Wexner Medical Center University Hospital and clinical professor of internal medicine at the Ohio State University College of Medicine in Columbus. These transfers may happen because the services or facilities needed to properly care for the patient are not available in the current location.

Hospital transfers can become a little murkier when the quality of care is potentially less of an issue. In these cases, it’s possible that care can be provided at the current location, or that an improved outcome may not be guaranteed by moving to a different facility. Ali says examples of this kind of transfer include a patient with complications needing greater medical intervention down the line that would require a transfer or “the severity of the condition is greater than typically cared for at their facility.”

In still other cases, those that Ali refers to as “transfers for a second opinion,” the receiving hospital will look for affirmative answers to two basic questions before approving the transfer:

• Does the patient require continued inpatient care?
• Could the transfer likely change the patient’s outcome given their current stage of disease and trajectory?

In all cases, facility transfers require the provider to order the transfer request, Ali says. “Patients or loved ones can facilitate initiating this process by openly asking their providers whether a transfer is necessary and would benefit the patient.”

How to Start a Hospital Transfer

Depending on the reason that you’re considering a hospital transfer, your tactics in pursuing it may differ. For patients seeking a transfer because they need access to a specialist or procedure not available at their current facility, the process involves:

• Clearing the transfer with the patient’s current physician(s).
• Getting approval from the hospital where the sought-after physician practices.
• Getting authorization or approval from the patient’s insurance company.

However, if you’re looking to transfer because of quality-of-care concerns, that can be a more challenging situation.
When a patient has to remain in the hospital under protest, the family, friends or patient’s advocate should ask for a social worker or patient relations professional to step in as an intermediary between all parties, Hallisy advises. “Usually,” she says, “by the time a family wants to change hospitals, there has been some type of issue involving a breakdown in communication.”

Transferring from one facility to another isn’t always easy. There’s no magic “transfer now” button you can push to set events in motion, and there’s no overarching authority or central agency you can turn to for support in making a transfer happen.

But that doesn’t mean there’s nothing you can do.

Steps for Transferring Hospitals

When considering a transfer, there are several steps you should take in moving forward. These include:

• Decide where you want to go.
• Contact your case manager.
• Contact your insurance company.