Ethan Rhodes
Establishing care at a different hospital may become necessary for a variety of reasons, including dissatisfaction with the quality of care, the hospital's inability to provide the required care, or the patient's preference for a hospital closer to their loved ones. Hospital transfers refer to the movement of patients between different departments of the same facility or between different healthcare facilities. It is important to consult with your insurance company before requesting a transfer to understand what costs are covered and to ensure compliance with patient transfer guidelines. While requesting a transfer, it is also crucial to remember that you must secure an accepting doctor at the new hospital.
| Characteristics | Values |
|---|---|
| Reasons for transfer | The hospital can't provide the care the patient needs |
| The patient or their family is dissatisfied with the quality of care being delivered | |
| The patient prefers a hospital closer to their loved ones | |
| The hospital doesn't deal with a high volume of a specific procedure | |
| The patient requires a specific type of procedure or care plan | |
| The patient requires dialysis | |
| Who initiates the transfer? | The patient |
| The physician at the sending hospital | |
| Transfer process | The sending hospital contacts other medical centers that offer the required service |
| The accepting hospital decides whether to accept the transfer | |
| The current hospital continues to search for another hospital if the first choice refuses | |
| Consult with your insurance company | |
| Consult with your doctor | |
| Guidelines | The Centers for Medicare and Medicaid Services (CMS) has established patient transfer guidelines that must be followed by Medicare-certified hospitals |
| The Emergency Medicine Treatment and Active Labor Act (EMTALA) applies to hospitals that accept CMS and HHS payments |
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What You'll Learn
Requesting a hospital transfer
If you wish to transfer to another hospital, the first step is to consult with your insurance company to ensure that your insurance will cover the transfer and any subsequent treatment at the new hospital. You may need to submit a request for pre-authorization and determine whether the new hospital is in-network with your insurer.
Next, you should reach out to the hospital you wish to transfer to and determine if they have the capacity and capability to provide the necessary care. This may involve consulting with the potential admitting physician from the new hospital, as well as your current attending physician and your physician of record. They will consider scientific evidence, your diagnosis, and your condition to determine if a transfer is medically justified.
If your transfer request is denied, you have the right to appeal the refusal. You can request a meeting with the hospital's ethics committee or speak directly to the chief medical officer, who may have the authority to overturn the decision. You can also seek assistance from a patient advocate or ombudsman, who can act as a liaison between you, the providers, and the insurers.
It is important to note that transfers can be complex and may be delayed due to staffing or bed shortages, insurance paperwork, or other administrative issues. Ensuring that all necessary parties are involved and informed, and that the appropriate documentation is in place, can help streamline the transfer process and ensure the patient's safety.
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Reasons for transfer
There are several reasons why a patient may need to be transferred from one hospital to another. Here are some common reasons for transferring care:
Lack of specialised expertise or resources:
The hospital may lack the specialised expertise, equipment, or resources required for the patient's specific medical needs. For example, a patient may require a particular procedure, such as interventional radiology, that the hospital cannot perform due to a lack of specialised staff or equipment.
Inadequate capacity:
A hospital may refuse a transfer request if it does not have the capacity to accommodate the patient, such as in cases of bed shortages or inadequate staffing.
Patient proximity to loved ones:
Sometimes, patients or their families request transfers to hospitals that are closer to their loved ones' residences. This facilitates easier visitation and improves the patient's overall well-being by having their support system nearby.
Dissatisfaction with the quality of care:
If a patient or their family is dissatisfied with the quality of care being delivered at the current hospital, they may request a transfer. This could be due to concerns about the standard of care, treatment methods, or any other factors that impact the patient's comfort and confidence in their care team.
Availability of specialised procedures:
Some procedures may be uncommon or high-risk, and patients may prefer to be transferred to a hospital with a higher volume of experience in performing those procedures. Advanced care centres that frequently deal with specific types of procedures often have the appropriate staff, equipment, and technology to provide specialised care.
It is important to note that transferring care is not unusual, and patients have the right to seek a second opinion and request transfers if they believe it is in their best interest.
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Transfer process
The transfer process can be a complex one, and there are several reasons why a patient may wish to transfer to another hospital. The two most common reasons are that the current hospital cannot provide the care the patient needs, or the patient or their family is dissatisfied with the quality of care being delivered.
The first step in the transfer process is to consult with your insurance company. You will need to find out if the hospital you wish to transfer to is in-network with your insurer and whether they will cover ambulance transportation if it is necessary.
The next step is to find an accepting doctor at the new hospital. It is the patient's responsibility to find a new doctor, and they will need to be willing to accept the transfer. If the new hospital is unable to provide the service needed, they may suggest an alternative hospital that can. The patient will then need to repeat this process with the new hospital.
Once an accepting doctor has been found, the patient's current hospital will need to document their stability before the transfer can take place. This is to ensure regulatory compliance and streamline the process.
It is important to note that patient transfers can sometimes be delayed due to staffing or bed shortages, or while necessary insurance forms are completed.
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Consulting insurance
Consulting your insurance company before establishing care at another hospital is an important step to take. Each insurance company has different rules for using healthcare benefits, so it is crucial to understand your specific plan's benefits and limitations. Some key points to consider when consulting your insurance company include:
- Network Coverage: Doctors and hospitals often contract with insurance companies to become part of their network. In-network providers have agreed-upon rates with the insurance company, resulting in lower out-of-pocket expenses for you. Before seeking care, consult your insurance plan's network to find in-network doctors and hospitals in your area.
- Emergency Care: In an emergency, your priority should be seeking immediate medical attention. Federal law protects you from out-of-network charges for emergency services, and insurers cannot require prior approval for emergency room services outside your plan's network. However, for post-stabilization services, you may be asked to sign a notice and consent form for out-of-network care if you can safely travel to an in-network provider.
- Urgent Care Centres: For non-life-threatening situations, consider visiting an urgent care centre or a retail-based clinic. Call your insurance company beforehand to ensure they will cover the treatment at these facilities.
- Specialist Referrals: Some insurance plans require referrals or pre-approvals to see a specialist. Failing to obtain the necessary pre-approvals may result in your insurer denying your claim.
- Pharmacy Networks: Check with your insurance company to see if they require you to use a pharmacy within their network. Pick a pharmacy close to you and inform your medical team of its name and contact information.
- Billing Practices: Understand the billing practices of your insurance company to avoid unexpected charges. Be aware of "bundling," where an insurance company groups multiple procedures into one claim, which can result in unexpected out-of-pocket expenses.
By consulting your insurance company and understanding your plan's specifics, you can make informed decisions about your healthcare and avoid unexpected financial burdens.
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Transfer guidelines
Identify Reasons for Transfer:
Firstly, understand the common reasons for patient transfers, which can include the following:
- The current hospital cannot provide the required level of care, specific procedure, or necessary equipment for a patient's needs.
- The patient or their family is dissatisfied with the quality of care and requests a transfer to a different hospital.
- The patient's loved ones are located far away, and they prefer a hospital closer to their support system.
Develop Clear Guidelines:
Create straightforward and detailed guidelines that outline the steps for initiating a transfer request. This includes designating a central transfer request area or department within the hospital, which can be a single point of contact for all transfers. Ensure that the guidelines specify the criteria for determining patient stability and clinical appropriateness for transfer, as mandated by the Emergency Medicine Treatment and Active Labor Act (EMTALA).
Consult with Insurance Providers:
Instruct patients to consult with their insurance company before requesting a transfer. This is to ensure that the desired hospital is in-network with their insurer and that ambulance transportation, if necessary, will be covered. Delays in completing insurance-related paperwork during a transfer can put patients at increased risk and lead to dissatisfaction.
Collaborate with Accepting Hospital:
Establish a collaborative process with the accepting hospital. This includes contacting nearby medical centers that offer the required service and confirming their capacity and capability to accept the patient. The sending hospital should provide all necessary patient information and documentation to facilitate a smooth transition.
Ensure Regulatory Compliance:
To ensure compliance with patient transfer guidelines established by the Centers for Medicare and Medicaid Services (CMS), incorporate these rules into your unique transfer policy. This includes documenting patient stability and clinical appropriateness for transfer, as well as specifying the sending physician's responsibility in the process. Regulatory compliance will streamline the transfer process and reduce potential complications.
Prioritize Continuity of Care:
By following these transfer guidelines, healthcare facilities can provide safe and efficient transfers, ensuring that patients receive the necessary care without unnecessary delays or complications.
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Frequently asked questions
There are two main reasons a patient might transfer from one hospital to another: the hospital can’t provide the care the patient needs, or the patient or their family is dissatisfied with the quality of care being delivered.
Every hospital has a central call area through which transfer requests are funneled. You must have an accepting doctor at the new hospital; it is not your current doctor’s responsibility to find one for you.
The hospital you are leaving will contact other nearby medical centers that offer the service you need and ask if they can accept a transfer. If the new hospital agrees to accept you, your current hospital will make the necessary arrangements.
Ask if the procedure you’re being offered is something that’s commonly performed at the hospital that’s treating you. If it isn't, you can request a transfer or a consultation with a physician who performs more of those procedures. You should also consult with your insurance company to find out if the new hospital is in-network and whether it will cover ambulance transportation.
The Centers for Medicare and Medicaid Services (CMS) has established patient transfer guidelines that must be followed by Medicare-certified hospitals. The Emergency Medicine Treatment and Active Labor Act (EMTALA) applies to hospitals that accept CMS and HHS payments. According to EMTALA law, the physician at the sending hospital is primarily responsible for determining patient stability and clinical appropriateness for a transfer.
