Case Management

Leaving against medical advice

Case Management Monthly, August 27, 2010

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Working with a patient who is leaving against medical advice (LAMA) can be difficult. Although the physician responsible for the patient’s medical care is primarily involved in this situation, discharge planners frequently become involved when the patient has continuing care needs. 

The rate of readmission or return to the ED is relatively high for LAMA patients. Therefore, establishing a multiprofessional protocol for managing these patients is wise.

CMS has changed both its postacute care transfer policy and general transfer policy. It includes patients discharged under code “07—Left Against Medical Advice (LAMA).” In the case of a patient who leaves a hospital against medical advice and is readmitted to another hospital the same day for the same condition, the discharge is considered a transfer unless the transferring hospital demonstrates that treatment was complete when the patient left.

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