Involuntary Discharge & Transfer

The number of displaced patients (patients with no facility willing to accept them) is a concern in Quality Insights Renal Network 4 and throughout the country. These patients are forced to go to hospital emergency rooms for treatment, thus contributing to an already over-burdened system, and also receiving little or no continuity of care. Quality Insights supports the recommendations on involuntary discharge from the Ethical, Legal, and Regulatory Subcommittee of the Decreasing Dialysis Patient-Provider Conflict Project.

Involuntary discharge is a last resort for managing difficult patient situations. The Conditions for Coverage (§ 494.180 (f)) recognize involuntary discharge for the following reasons:

• The patient or payer no longer reimburses the facility for the ordered services;

• The facility ceases to operate;

• The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs; or

• The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired.

For information about the involuntary discharge process as outlined by the Centers for Medicare & Medicaid Services (CMS), download this fillable PDF of the Involuntary Discharge and Involuntary Transfer Packet.