Glossary - Your Rights as a Hospital Patient in New York State

Advance Directives
Advance directives are verbal or written instructions made by you before an incapacitating illness or injury (see "Planning in Advance"). Advance directives communicate that your wishes about your treatment be followed if you are too sick or unable to make decisions about your care. Advance directives include but are not limited to a health care proxy, a consent to a do-not-resuscitate (DNR) order recorded in your medical record and a living will.
Cardiopulmonary Resuscitation (CPR)
CPR is a medical procedure used to restart a patient's heart and lungs when your breathing or circulation stops (more information).
Diagnosis Related Groups (DRGs)
The diagnosis related group (DRG) system categorizes the entire range of reasons people are hospitalized into about 600 groups to determine how much the hospital will be paid by your insurance. The DRG system is based on the average cost of treating a patient within the same age range, diagnosed with the same or similar condition and needing the same type of treatment. For example, one amount is paid for patients with pneumonia and a different amount for patients with a broken hip. It takes into account a hospital's expenses, regional costs, inflation and patient needs. The New York State Department of Health has developed Medicaid and Workers Compensation/No Fault payments rates for each DRG within each hospital. This does not limit the number of days a patient may stay in the hospital. Your length of stay depends solely on your medical condition. (Note: Certain specialty units and facilities do not use DRGs.)
Discharge Notice
A New York State hospital discharge notice should include information on your discharge date and how to appeal if you disagree with the notice. A discharge notice must be provided to all patients (except Medicare patients who receive a copy of an "Important Message from Medicare") in writing 24 hours before they leave the hospital. Medicare patients must request a written discharge notice (also called a Hospital Issued Notice of Noncoverage or HINN) if they disagree with discharge. If requested, the notice must be provided. Once the notice is provided and if the Medicare patient disagrees with the notice, an appeal can be processed.
Discharge Plan
All patients (including Medicare patients) in New York State hospitals must receive a written discharge plan before they leave the hospital. This plan should describe the arrangements for any health care services you may need after you leave the hospital. The necessary services described in this plan must be secured or reasonably available before you leave the hospital.
Discharge Planning
Discharge planning is the process by which hospital staff work with you and your family or someone acting on your behalf to prepare and make arrangements for your care once you leave the hospital. This care may be self care, care by family members, home health assistance or admission to another health care facility. Discharge planning includes assessing and identifying what your needs will be when you leave the hospital and planning for appropriate care to meet those needs when you are discharged. A plan must be provided to you in writing before you leave the hospital. Discharge planning usually involves the patient, family members or the person you designate to act on your behalf, your doctor and a member of the hospital staff. Some hospitals have staff members who are called "discharge planners." In other hospitals, a nurse or social worker may assist in discharge planning.
Do-Not-Resuscitate (DNR) Order
At your request, a DNR order may be included in your medical chart. It instructs the medical staff not to try to revive you if your breathing or heartbeat has stopped. This means that doctors, nurses and other health care practitioners will not initiate such emergency procedures as mouth-to-mouth resuscitation, external chest compression, electric shock, insertion of a tube to open your airway, injection of medication into your heart or open chest. Under New York State law, all adult patients can request a DNR order verbally or in writing if two witnesses are present. In addition, the Health Care Proxy Law allows you to appoint someone to make decisions about DNR and other treatments if you become unable to do so.
Health Care Proxy form
New York State has a law that allows you to appoint someone you trust, for example, a family member or close friend as your Health Care Agent, to decide about your treatment if you lose the ability to decide for yourself. You may also use this form to indicate your wishes regarding organ donation in the event of your death (see Health Care Proxy).
Independent Professional Review Agents (IPRA)
These review agents handle appeals for patients covered by Medicaid, private insurance or those without any insurance if they are having problems getting the care they will need after discharge from the hospital. For example, an IPRA would review the medical records of patients who are discharged before they are medically ready, and if an appropriate discharge plan has not been done or if appropriate services were not in place.
IPRO
This is the quality improvement organization contracted by the federal and state government to review the hospital's care provided to Medicare and Medicaid patients in New York State.
  • This is the agency Medicare patients should contact if they think they are being discharged too soon from the hospital. Call toll-free at 1-800-446-2447 or 1-516-326-6131.

    If you have complaints about the quality of care you receive as a Medicare patient, call the Medicare Hotline tollfree at 1-800-331-7767.

  • IPRO also works with the New York State Department of Health to conduct the review of hospital care provided to people who are eligible for Medicaid. This is the agency Medicaid patients should contact if they think they are being discharged too soon from the hospital. Call toll-free 1-800-648-4776, or 1-516-326-6131.

    Medicare and Medicaid patients may also write IPRO at:

    IPRO
    1979 Marcus Avenue
    Lake Success, New York 11042
Living Will
A living will is a written document that expresses in advance your specific instructions and choices about various types of medical treatments and certain medical conditions. Living wills may be recognized as evidence of your wishes (if such wishes are expressed in a clear and convincing manner) if you are seriously ill and not able to communicate.
Managed Care
Managed care refers to the way an individual's (or family member's) health care is organized and paid for. While health maintenance organizations (HMOs) are the best known managed care plans, there are many other types. If you are enrolled in a managed care plan, your access to health care services is coordinated by the plan and/ or primary care physician. Therefore, you should understand how, when and where to access health care services, including hospital services, according to your plan's rules and benefits. Read your plan's enrollment information carefully and ask questions of your plan representative to be sure you understand your benefits, rights and responsibilities.
Medicaid (Title XIX of the Social Security Act)
Medicaid is a federal program, financed by federal, state and local governments, intended to provide access to health care services for the poor, specifically those who meet certain eligibility requirements such as income level.
Medical Misconduct
If you feel you have received poor or substandard care (incompetent, negligent or fraudulent care) from a doctor or physician assistant, you may file a report with the New York State Department of Health. Physicians and other health professionals are required by law to report any instance of misconduct.

Some examples of medical misconduct are:

  • practicing the profession fraudulently, through gross incompetence or gross negligence;
  • practicing while impaired by alcohol, drugs, physical disability or mental disability;
  • being convicted of a crime;
  • refusing to provide medical services because of race, creed, color or ethnic origin;
  • guaranteeing that a cure will result from medical services;
  • failing to make available to the patient or another physician, upon a patient's written request, copies of X-rays or medical records;
  • willfully making or filing a false report, or failing to file a report required by law or inducing another person to do so;
  • willfully harassing, abusing or intimidating a patient;
  • ordering excessive tests or treatment;
  • promoting the sale of services, goods, appliances or drugs in a manner that exploits the patient;
  • abandoning or neglecting a patient in need of immediate professional care.
Medicare (Title XVIII of the Social Security Act)
Medicare is a federal program, administered by the federal government, which pays part of the costs of medical services for people aged 65 or older or who are disabled. Eligibility rests solely upon age or disability.
Patient Representative
the patient representative is a member of the hospital staff who serves as a link between the patient, family, physicians and other hospital staff. The patient representative should be available to answer questions about hospital procedures, help with special needs or concerns and help solve problems. The patient representative is familiar with all hospital services and will assist you. There is no charge for services rendered by the patient representative.
Quality Improvement Organization (QIO)
QIOs are the agencies responsible for ongoing review of the inpatient hospital care provided to people who are eligible for Medicare. In New York State, the QIO is IPRO (see definition).
Utilization Review
Utilization review is a process where the need, appropriateness and effectiveness of care are evaluated. This is performed by a hospital utilization review (UR) committee, a Quality Improvement Organization (QIO) (see QIO), a public agency (health department, for example) or an independent organization.