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Medicare Enrollees Leaving Hospitals Against Medical Advice

Announced on  | Last Modified on  | Project Number: A-04-24-03003
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Hospitals indicate on a claim that a patient left against medical advice (AMA) with a specific patient discharge status code—“07,” which stands for “left against medical advice or discontinued care.” According to some academic researchers, the AMA designation indicates a higher risk that a patient experienced poor quality health care. The researchers also note that hospital stays coded with the AMA designation may be associated with increased patient morbidity and mortality percentage rates. In addition, the researchers note that historically medically underserved groups of patients are more likely than other groups to receive the AMA designation. The percentage rates that hospitals have been designating that Medicare enrollees left AMA have increased over the past three decades. This data brief will analyze the percentage rates and outcomes for enrollees that hospitals designate as left AMA as well as provide CMS and other stakeholders with information that can be used to address health disparities and improve enrollee outcomes.

TIMELINE

  • June 17, 2024
    Announced
  • August 18, 2025
    Complete

    Medicare Enrollees Leaving Hospitals Against Medical Advice has been marked as complete. Report Published

REPORT PUBLISHED

Medicare Enrollees Left Acute-Care Hospitals Against Medical Advice at Increasing Rates (A-04-24-03003)

After being admitted as acute-care hospital inpatients, Medicare enrollees with decision-making capacity, or their surrogates, can discharge themselves and leave against medical advice (AMA) Acute-care hospitals record an enrollee’s discharge status using a code on the claim. For example, they use a specific code if they discharge an enrollee to their home (01) and another if they transfer theenrollee to a different acute-care hospital(02). Hospitals designate that an enrolleeleft AMA using code 07.

Our objectives were to 1) analyze rates and outcomes for Medicare enrollees at acute-care hospitals who leave AMA and 2) provide the Centers for Medicare &Medicaid Services (CMS) and otherstakeholders with information that can beused to improve enrollee outcomes.

No recommendations were issued as a part of this report.
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship Hospitals Quality of Care
Target Groups
Elderly Other Minorities
Financial Groups
Medicare A