Leaving the Hospital Against Medical Advice

Most of the time, healthcare providers and their patients agree on when it is time to leave the hospital. Sometimes, though, you may have different ideas about what is best for you or a loved one.

Sometimes a person decides to leave the hospital against a provider's advice. When this happens, the case is labeled a discharge "against medical advice" (AMA).

This label is used in part to protect providers and the hospital from liability. This is important because it's possible a person may become ill or die as a result of the early discharge.

This article discusses AMA discharge and its potential risks. It also looks at some of the reasons why you may want to leave the hospital early, and what you should consider before making this decision.

Why Hospitals Want Patients to Stay

Patients sometimes think hospitals might not have their best interests in mind. They may feel like hospitals are only keeping them so they can charge more. Usually, though, the reasons have to do with a person's safety.

Some discharge guidelines are built into the law. The Hospital Readmissions Reduction Program (HRRP) under the Affordable Care Act is one example. Under HRRP, hospitals are penalized if Medicare patients return to the hospital within 30 days of discharge.

This program is meant to ensure that people don't leave the hospital before they are well enough.

Ethical and legal concerns may also encourage healthcare providers to keep people in care for what may seem longer than necessary. This may be because medical malpractice is such a big concern.

Still, there is no evidence that hospitals often hold people for nonmedical reasons. This is particularly true when it comes to AMA discharges.

In the United States, the total number of people who leave the hospital AMA is relatively small. A 2023 report of 3.3 million records studied from 989 hospitals found 1.6% of people left the emergency department AMA. The numbers were higher for:

• People with no insurance (2.8%)
• People ages 35 to 49 (2.2%)
• Black people at 2.1% (Latinx and White people had comparable rates of about 1.5% each)
• People with lower incomes (1.9%)

There are quite a few different reasons for people to leave AMA, from simply deciding they were feeling better to concerns over the quality of their care or its cost.

Before You Decide to Leave AMA

Leaving a hospital AMA is a serious decision and many people make this choice because of cost.

If you have a high-deductible health insurance or are paying cash, every day in the hospital costs you more money. Extra days can leave you with mounting medical bills you can't afford.

Dealing With Billing Concerns

The high cost of hospital care is an important concern. Before you decide to leave, though, there are people on staff at the hospital who can help you with these issues.

A patient advocate, patient representative, or ombudsman can meet with you to review your bill. They can also discuss ways to get help with the costs or pay your bill in installments.

If you have proof of extreme financial distress, you can request a reduction of your bill. In some cases you may even be able to ask for forgiveness. Most hospitals also offer a 0%-interest repayment plan.

Addressing Legitimate Complaints

Sometimes people choose to leave the hospital because they feel they are receiving poor care. They may also disagree about what type of care they should get. Sometimes they may feel that hospital errors have put their health at risk.

However, do not leave without first lodging an official complaint. You can bring your concerns to the attention of hospital administration or speak to a hospital social worker.

For legal reasons, hospitals take serious reportable events (SREs) seriously. They usually take swift action to correct the error or find a solution. They may even transfer you to another hospital.

Until the problem is resolved and you are happy with the outcome, don't sign anything that absolves the hospital of liability for the SRE. Make sure you have a patient advocate to help you negotiate.

If the hospital's solution will increase your medical costs, insist that the hospital cover those costs. If your complaint is valid, they will almost certainly agree.

Weighing the Pros and Cons

Some people may leave simply because they do not like hospitals. They may have had a bad experience in the past. They may also have fears about antibiotic-resistant infections like methicillin-resistant Staphylococcus aureus (MRSA).

If these are your concerns, speak with your healthcare providers. Keep an open mind when discussing your issues.

Try to stay objective. Weigh the costs and benefits of leaving with the costs and benefits of staying. If you are in poor health, you may not be able to make an informed decision on your own. In this case, find a family member, a trusted friend, or a private patient advocate to advocate on your behalf.

Contact the National Patient Advocate Foundation at 800-532-5274 for help with professional referrals.

If You Decide to Leave AMA

If you are considering leaving the hospital AMA, there are a few things to be aware of:

• If you want to leave, you probably can. The only exception may be for mental health patients who are at risk of harming themselves or others.
• AMA discharges do not void the terms of your insurance. Leaving AMA will not result in a refusal of payment. It will not trigger an increase in your insurance premium, either. It is possible, though, that you will have more medical expenses if you have to be readmitted because of the early discharge. Leaving AMA increases the risk of readmission.
• You will be asked to sign discharge papers. This document is separate from any SRE complaint you may have filed. These papers state that you have chosen to leave against your healthcare provider's advice. Have an advocate on hand to review the document. Make sure you understand the terms.
• Know that you do not have to sign those papers. You have the legal right to leave. There is no law that requires you to sign discharge documents. Still, you should prepare a letter that explains why you decided to leave. Keep a copy of the letter and give a copy to the hospital administrator.

Summary

You have a right to leave the hospital against the advice of your healthcare providers. Still, you should be aware of the risks of doing so.

Hospitals usually decide whether to keep you in care based on valid medical reasons. However, you may decide to leave because of high costs, poor care, or past bad experiences.

Whatever your decision, it is important to talk to a patient advocate and hospital administration first. You may be able to resolve your problems without having to leave AMA.

If you do leave, make sure you understand your rights and the consequences of your decision.