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Based on record review, interview and policy review, the facility failed to ensure a patient was provided a Medicare notification to appeal a discharge from the hospital. This affected one (Patient #21) of two patients reviewed for Medicare benefits.

Findings include:

Patient #21 was admitted to the emergency department (ED) on 9/02/23 at 2:20 PM after being found unresponsive at his rehabilitation center. Physician notes listed this patient had a history of substance abuse presenting from a recovery center due to concerns for possible overdose.

Emergency room notes stated this patient's glasgow coma scale (GCS) ranged between three and 11 (15 is fully awake) and was not responding to questions. This patient was intubated in the ED and transferred to the intensive care unit (ICU) at 5:55 PM.

This patient was taken off the ventilator on 09/04/23 at 11:06 AM. A fasciotomy was completed on 9/05/23. A debridement and application of a wound vac was completed on 09/07/23 in the operating room.

Discharge planning began on 9/06/23 by the discharge coordinator (Staff Y). Plan at this time was to find an in-patient acute rehabilitation closer to his home out of state per patient and his father's request.

Discharge coordinator notes dated 09/25/23 at 3:12 PM documented during discharge rounds, multiple inpatient rehab facilities are denying to accept Patient #21 due to the substance abuse history. Care navigation following up on several skilled nursing facilities (SNF) referrals that were sent on 09/22/23. Initiated discussion with patient and father in reference to discharging home with home care and outpatient therapy. A note dated 09/26/23 at 2:03 PM documented there were continuing barriers to discharge and discussed with medical staff.

The discharging physician (Staff X) progress note dated 09/27/23 at 2:40 PM stated the hospital was still working on disposition for inpatient rehab versus skilled nursing facility placement close to home but patient had refusal from multiple facilities. This Patient's father was again frustrated this morning that he is not clear about the timeline when he is should expect healing of wounds, wound care following from here. Appropriate support provided to father and he was reassured that every loose end will be addressed prior to discharge. He is also given tentative date for discharge for 09/29/23 to either an inpatient rehab or home with home health.

The surgeon's (Staff W) progress note dated 09/27/23 stated they feel this patient can convert to a different dressing and discontinue the wound vacuum. Discharge planning and care navigation can continue to work towards potentially discharge to home and follow up with the wound care clinic near home.

Discharge Planning notes dated 09/29/23 documented Patient #21 was being discharged home with home health care, wound care and physical therapy. Home care to start on 10/01/23 or 10/02/23. Planning discharge later today, patient and his father verbalized understanding.

Review of the discharge nursing notes dated 09/29/23 by Staff AA documented the discharge paperwork was reviewed with patient and their family. Patient agrees with plan of care, although the father does not. Supplied patient and father with information on discharge, bandages, and appointment information. Left leg wrapped with an ace wrap per patients request, then walking boot was placed. Patient was able to dress himself independently and walk to the wheelchair with a walker without difficultly. Patient left unit in wheelchair to private car. Discharged home with a seven day supply of Oxycodone 20 milligrams (mg) every four hours.

Review of the record revealed Patient #21 was not provided the Important Message from Medicare (IMM) 48 hours prior to discharge.

During an interview on 03/21/24 at 4:00 PM, Staff B verified Patient #21 was not provided the IMM to have an opportunity to appeal the discharge.

The facility policy titled "Assisting Patients with Discharge Appeal", dated 03/17/22, documented the purpose was to ensure that Medicare beneficiaries an exercise their rights to have their hospital stay reviewed if they believe they are being discharged too soon. Every Medicare beneficiary who is admitted to inpatient status, is given the Important Message from Medicare (IMM) upon admission and 48 hours prior to discharge. If a patient chooses to exercise their discharge appeal rights with the Quality Improvement Organization (QIO), ProMedica Health System staff assists the patient with this appeal. If a patient wishes to appeal a discharge, the QIO is contacted before the patient leaves the hospital. If the QIO is contacted, the patient is not financially responsible for services they received during the appeal process except for co-pays and deductibles.