The Network's Role in Preventing and Reducing Involuntary Discharges

We receive frequent calls regarding the process of involuntarily discharging a patient under the Conditions for Coverage. Let us first emphasize that involuntary discharge should be the option of last resort. Discharged patients are at high risk for morbidity and mortality. Facilities should train staff in conflict management techniques and work to remove any barriers that patients may be facing.

The medical director ensures that no patient is discharged or transferred from the facility unless:
1 . The patient or payer no longer reimburses the facility for the ordered services;
2. The facility ceases to operate; or
3. The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs.
4. 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.
5. Immediate severe threat to the health and safety of others.

Network 6 Patient Services Department

Chanell McCain, MSW
Patient Services Director
Main Line: 919-463-4523
chanell.mccain@ipro.us

Vanessa Talley
Community Outreach Coordinator
Main Line: 919-463-4529
 vanessa.talley@ipro.us

Helpful Definitions

  Involuntary Discharge (IVD): an involuntary discharge is a discharge initiated by the treating dialysis facility without the patient’s agreement

  Involuntary Transfer (IVT): an involuntary transfer occurs when the transferring facility temporarily or permanently closes due to a merger, or due to an emergency or disaster situation, or due to other circumstances, and the patient is dissatisfied with the transfer to another facility

Failure to Place: a situation in which no outpatient dialysis facility can be located that will accept an ESRD patient for routine dialysis treatment.

Working with the ESRD Patient

The Network has resources for healthcare providers to assist in clinical practice and to deal with difficult situations. If you are having difficulty placing a patient in an outpatient dialysis facility, your first resource is Medicare's Dialysis Facility Compare to search and compare dialysis facilities in the United States and Territories. If you are still having issues placing patients in outpatient dialysis facilities, please contact Network Staff to discuss options and potential interventions for overcoming barriers to placement.

Tools & Resources

If provider staff is dealing with a situation that they feel may warrant a patient's involuntary discharge (IVD) or transfer (IVT), please be aware that the Network and State Department of Health MUST be notified when ANY notice of termination or transfer is given to a patient.

IVD/IVT places patients at extreme risk and should be considered ONLY as a last resort. IVDs and IVT's are tracked by the Network and reported to CMS monthly. In addition, patients who do not have a Health Care Proxy or Emergency Contact Person are also considered at-risk.  In many cases, we have found that early interventions have prevented discharge and we urge facility staff to identify patients who are at risk early and to contact the Network's Patient Services department for assistance.

Resources:
Decreasing Patient-Provider Conflict: DPC Toolkit
Dialysis Patient Grievance Toolkit  (English|Spanish)
 Addressing Threats

Dialysis Facility Involuntary Discharge Guidelines
When Patients Don't Come to Dialysis
CMS Conditions for Coverage IVD Guidelines