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Notifying patients of their right to complain
Rule would require formal notification
Case managers are likely to have additional duties added to their workload under a proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) that would require providers to formally notify Medicare beneficiaries of their right to communicate concerns about the quality of the care they received to the state Quality Improvement Organization (QIO).
The proposed rule (CMS-3225-P) also would require providers to give all patients, Medicare or otherwise, the name and contact information for the state survey organizations and to document that all inpatients and outpatients have received the information in writing.
"The rationale for this proposed rule is to raise awareness among Medicare beneficiaries about how they can exercise their right to complain to the QIO or state surveyor about the care they received," says Jackie Birmingham, RN, MSN, MS, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group.
The proposed rule would apply this requirement to patients receiving care in the hospital and in the outpatient setting as well. Other facilities including ambulatory surgical centers, hospices, long-term care facilities, home health agencies, comprehensive outpatient rehabilitation facilities, critical access hospitals, rehabilitation agencies, portable X-ray services, rural health clinics, and federally qualified health centers would also have to provide the information and document it.
"This rule comes on the heels of the CMS notice about the value-based purchasing program for the acute care prospective payment system. Value-based purchasing for hospitals will base payments on quality and outcomes, rather than volume, and patients are one of the best sources of information about quality. When patients have a bad experience, they will have a local name and phone number to contact. I suspect that the number, type, and outcome of patient complaints to the QIO will eventually feed back to the value-based purchasing method of payment," Birmingham says.
She adds that a section in the proposed rule for value-based purchasing proposes to change the rule about what information QIOs can release, what is protected, and what will be open to inquiries.
It's not too soon to develop strategies about how to inform your patients of their rights and to take proactive steps to improve the patient care experience and the process for handling complaints, Birmingham says. Look for ways to empower patients to provide feedback good and bad and make it easier for patients to contact you about quality concerns, she says. Find out what the patients are concerned about, and act before the patient feels the need to take their complaints further, she suggests.
"It's not just about giving patient a piece of paper with contact information. It's reminding patients at every opportunity that you care about them," she says.
For more information, contact: Jackie Birmingham, RN, MS, Vice President of Regulatory Monitoring for Curaspan Health Group. E-mail: firstname.lastname@example.org.
To access the proposed rule in the Feb. 2, 2011, Federal Register, visit http://www.gpo.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-2275.pdf