Arranging an interhospital transfer from a good hospital to a great one

April 3, 2015 8:17 PM

My last question was about coordinating care among physicians at different hospitals. It's not working. Now I need to know the safest (but also insurance-covered) way to get my baby to the better hospital in a future crisis. Please share your interhospital transfer (or other related) experiences.

Nanopanda is in the PICU at Suburban Tertiary Care Hospital (STCH) for the third time in two months (fourth total). I feel that she's receiving good PICU care, but I am NOT HAPPY with the pulmonology care she's getting, and she's on the pulmonary service so they get to call the shots. The two pulmonologists switched off hospital duty in the middle of the week and did not create any kind of coordinated care plan; instead we got two sets of diagnosis/treatment plans that are orthogonal and incompatible with each other. Determining which is correct requires a bronchoscopy which cannot be done in her current condition (it was scheduled but the anesthesiologists called it off). STCH pulmonologists are not consulting with our doctor at Downtown MegaKids Hospital. I have spoken with the doctor at DMKH, and we are going to leave Nanopanda at STCH for the duration of this admission because for the moment she is only receiving supportive care that would not be fundamentally different at DMKH.

We are scheduling the big workup ASAP at DMKH. However, in the event that we have another emergency before the big workup (or if there is a future emergency), I would like to have the option of taking Nanopanda to DMKH.

Given that both hospitals have dedicated pediatric emergency rooms, pediatric intensive care units, and pediatric pulmonary subspecialists, what is the safest way to get Nanopanda to DMKH, what are the words to say to make it happen, and what are the words to say to get insurance to cover it? (Blue Cross PPO, FWIW)

Do we grit our teeth and drive her 45 minutes (plus maybe traffic) downtown in an emergency, figuring that if I sit in the back with her and keep giving albuterol that's basically what they'd be doing for the first hour in the ER anyway? An ambulance via 911 is going to take us to STCH. Would a private ambulance take us to DMKH? Would insurance cover that? Or do we take her to the ER at STCH and then request an interhospital transfer to DMKH? Again, given that all services she needs are present at STCH, how do we word the justification? ("I think the pulmonologist is an ass" isn't going to get us very far.)

Of course this is something to discuss with our doctor at DMKH, and I will, but I find that in general physicians are not especially up on insurance related issues or how to be just the right kind of combative. This is where the Hive comes in. Please tell me about your interhospital transfer experiences, or your decision making process when you really need to get someone to a specific hospital for reasons that are good but might not sound so on paper.

posted by telepanda to Health & Fitness (10 answers total)

EMTs, in my understanding, are legally required to take you to your requested treatment location.
posted by jaguar at 8:41 PM on April 3, 2015

Talk to you primary care physician about initiating a transfer. You don't want to just out of the blue show up or try this on your own. My daughter was 2 days old and at her first checkup when her Tracheomalacia showed up (anxiety at the doctor's office, collapsing airway), and her Pediatrician put her on oxygen and called in a special ambulance to take her to the Children's Hospital. They knew their shit and did everything perfect. She's 15 months old, doing great, and I do not regret letting professionals handle transfer to a hospital for a second.
posted by nickggully at 8:45 PM on April 3, 2015

Response by poster: If we operate under the assumption that trying to get her to DMKH ourselves is a dumbassed thing to do (I don't disagree), what is the script to convince the ER docs (or the PICU docs?) and the insurance company that a transfer is medically necessary? No one would argue that DMKH isn't bigger and fancier, but again, on paper, STCH offers the services Nanopanda needs. It's just that I think that service is handling her poorly, and DMKH's pulmonary program is nationally highly ranked, so surely they can do better.
posted by telepanda at 9:40 PM on April 3, 2015

My experience as ED doc has suggested that people can get transferred simply by saying they don't want to be at hospital A, they want to be at hospital B. Really nothing more complicated than that. I'm not sure why that's acceptable, honestly (because cost wise it seems like it shouldn't be), but it definitely happens. Not when they are unstable, though - then they go to wherever's closest.

Do not drive there yourself. It's absolutely not safe to try to do continuous albuterol unmonitored.

As for your insurance, you need to talk to them about what they cover.
posted by treehorn+bunny at 11:18 PM on April 3, 2015 [4 favorites]

My experience with transfers is that they typically occur when Hospital A is unable to provide a higher level of care that Hospital B offers. (i.e., availability of a sub specialist, ICU or procedure). It can sometimes be tricky, insurance-wise because the insurance company does not especially want to pay for the ambulance to transfer, or for another new admission at the other hospital. (Payments are often bundled, so that hospitals get the same amount of money for a patient with X amount of complexity regardless of their length of stay. That means if Nanopanda is admitted at STCH, stays for 1 day, and then is transferred to DMKH, the insurance company has to pay full rates twice). So I would say to talk to your insurance company about under what circumstances they would pay for a transfer, and to the admitting department at DMKH about what needs to happen to transfer someone over. Fortunately you already have a doctor there who would presumably be willing to accept the transfer.
posted by The Elusive Architeuthis at 7:11 AM on April 4, 2015 [1 favorite]

Best answer: DMKH probably has a social worker or case manager you could talk to about how to deal with this situation. That person would likely know more about how insurance and logistics work than your doctors do, but would also understand that you're not just being skittish, that it actually is medically better for your child to be at their facility. Ask your doctor or a staff member you trust at DMKH whether there's a case manager you could talk to.
posted by decathecting at 7:34 AM on April 4, 2015 [8 favorites]

I deal with transfers to my hospital all the time. We describe them as transfers for a "higher level of care" or "lateral transfers." With necessary services available at both hospitals, no amount of clever wording is going to convince an insurer who deals with this all the time that your situation is anything other than the latter. In my experience, with lateral transfers they won't cover the transfer bill.

If nanopanda is facing a life-threatening emergency, the safest/ethical thing to do is for first responders to take him to the nearest hospital with necessary services.

Frankly if nanopanda has a chronic illness that necessitates frequent hospitalization, the best way to get to DMKH is to foresee a hospital visit coming, and act before a drive to DMKH becomes too dangerous without an ambulance.
posted by drpynchon at 8:58 AM on April 4, 2015 [1 favorite]

I agree that a lateral transfer is hard. You could ask for the Utilization Review nurse in charge of your care and just ask something like, "what would we have to do to transfer to x hospital? " be prepared for them to say it's not possible.

Consider that x other hospital had as yet unknown problems of their own.
posted by latkes at 3:26 PM on April 4, 2015

I'm sorry you're dealing with this.
posted by latkes at 3:27 PM on April 4, 2015

Former public 911 EMT here. If a patient asks, we would often drive to a more distant hospital, as long as it didn't endanger the patient and it wasn't a super busy night.
posted by Ausamor at 4:50 AM on April 5, 2015