Planning a Hospital Stay Health Article

Definition

Planning a hospital stay includes determining what hospitals or facilities are covered by the patient's insurance plan, evaluating the credentials of the health care providers and hospital, gathering information about the hospital, including services offered, scheduling the hospital stay, completing pre-admission testing, receiving and following all of the appropriate pre-admission instructions, registering at the hospital upon arrival, as well as completing an informed consent form.

Purpose

Patients are admitted to the hospital for a variety of reasons, including scheduled tests, procedures, or surgery; emergency medical treatment; administration of medication; or to stabilize or monitor an existing medical condition.

Planning a hospital stay helps the patient understand what to expect before admission to the hospital and ensures the patient is physically and psychologically ready.

Description

If the hospital stay was planned, some of the steps involved in preparing for the hospital stay will take place one to two weeks before the patient is admitted to the hospital. Many of these steps will not apply if the hospital stay was unexpected or was the result of an emergency.

Determining insurance coverage

Although there are many types of hospitals available to meet the needs of different patients, the patient's choice of hospital may be limited by his or her insurance plan. The patient should find out if the selected hospital is approved by his or her insurance plan. If the patient receives care from a facility that is not approved by the health care plan, the patient may be responsible for paying for most or all of the medical expenses related to the hospital stay.

Managed care insurance plans often require pre-certification before any hospital stay, except for emergency hospital admissions. Usually, the patient's doctor has to authorize the hospital stay, and some types of care provided in the hospital may require insurance clearance.

If the patient has Medicare insurance (for patients over age 65), a semiprivate room, meals, general nursing care, and other hospital services and supplies are covered services. Those services not covered by Medicare include private duty nursing, a private room (unless medically necessary), and television and telephone fees.

The patient may desire to seek a second opinion to confirm the doctor's treatment recommendations. The patient should check with his or her insurance provider to determine if the second opinion consultation is covered.

FOR PATIENTS WITHOUT INSURANCE COVERAGE. For patients who do not have insurance coverage, other payment options and sources of financial aid can be discussed. The patient should ask to speak with the hospital's financial counselor for more information.

Evaluating credentials

The patient should find out if the physicians who will provide care in the hospital are board certified. Even though board certification is not required for an individual physician to practice medicine, most hospitals require that a certain percentage of their staff be board certified. There are 24 certifying boards recognized by the American Board of Member Specialties (ABMS) and the American Medical Association (AMA). Most of the ABMS boards issue time-limited certificates, valid for six to 10 years. This requires physicians to become recertified to maintain their board certification—a process that includes a credential review, continuing education in the specialty, and additional examinations.

A physician's membership in professional societies is also an important consideration. Professional societies provide an independent forum for medical specialists to discuss issues of national interest and mutual concern. Examples of professional societies include the Society of Thoracic Surgeons (STS) and the American College of Physicians–American Society of Internal Medicine (ACP-ASIM).

To find information about a physician's qualifications, the patient can call a state or county medical association for assistance. A reference book is also available, The Official ABMS Directory of Board-Certified Medical Specialists, that lists all physicians who are certified by approved boards. This publication also contains brief information about each physician's medical education and training, and it can be found in many libraries.

Evaluating the health care team

Selecting a hospital that has a multi-disciplinary team of specialists is important. The medical team should include surgeons (as applicable), physicians who specialize in the patient's medical condition (such as cardiologists for heart disease and pulmonologists for lung disease), infectious disease specialists, pharmacologists, and advanced care registered nurses. Other medical team members may include fellows, residents, interns, clinical coordinators, physical therapists, occupational therapists, respiratory therapists, registered dietitians, social workers, and financial counselors.