Medicare Enrollees Left Acute-Care Hospitals Against Medical Advice at Increasing Rates

Key Takeaways

• The rates at which enrollees leave acute-care hospitals against medical advice (AMA)have steadily increased since 2006 across most demographics we analyzed and spiked during the COVID-19 public health emergency.
• Enrollees who left AMA were more likely to have poor health outcomes than enrollees discharged to their homes.
• The rates at which enrollees have left AMA appear inversely correlated to the quality-of-care ratings of the associated hospitals—the lower the rating, the higher the rates.
• Enrollees eligible for both Medicare and Medicaid (dual enrollees) and enrollees with a mental health diagnosis were more likely to leave AMA than Medicare-only enrollees and enrollees without a mental health diagnosis, respectively.
• This data brief may be beneficial in the development of future guidance to address this growth, which could improve enrollee health outcomes and save taxpayer dollars.

Purpose of this Data Brief

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.