You might have come across instances where you feel that the quality of care that you got in the hospital was not up to your satisfaction, but you nevertheless desisted from making a formal complaint because you were unsure how to do so or just wanted to stay away from any hassles. The US federal authorities in the constant endeavor to improve the quality of care have taken several steps to address patient grievances.
Types of Patient GrievancesA patient grievance can be classified into three broad categories:
In the hospitalIf you have any complaints regarding the quality of care while in the hospital, bring it to the notice of your nurses and doctor. Be specific and ask for steps to resolve your complaints. You can get in touch with your hospital social worker for help in solving the problem and/or identify resources that can help you do so.
Some common quality of care complaints are:
- Wrong medication provided by a skilled nursing facility (SNF) or hospital
- Unnecessary diagnostic testing/surgery
- Medication overdose
- Delay in service
- Inadequate care/treatment from Medicare linked doctor or hospital
- Overlooking of change in medical condition
- Inadequate discharge instructions
Discharged before timeInsurance companies do not like long hospital stays and many patients feel that they are discharged before they are medically fit. If you feel that you are one of them, you can have a talk with the hospital discharge planner. The discharge planner will take up your concerns with the concerned doctor.
If you have Medicare or Medicare managed plan, then you can appeal about the discharge while you are still hospitalized. Once an appeal is filed, you will get a document titled “An Important Message from Medicare," which will explain the appeal process. These appeals are free and don’t take more than 2 to 3 days to get resolved. You cannot be discharged while the appeal process is still underway.
Hospital billFirst, ask the billing department to explain the charges levied. Find out the process to make a formal complaint about the billing practices and then file a complaint. If questions still persist, contact the Medicare Carrier which handles the billing issues for your program.
The Actual ProcessThere is Department of Public Health in every US state that deals with health and safety of the residents. Hospitals are mandated to report specific diseases, including hospital infections, to local Department of Public Health which accepts the report, conducts the investigation, laboratory testing (if required), and issues recommendations. Many US states also have set up laws to deal with hospital infections and medical errors. These mandates hospitals to report these events to respective state health departments which evaluates and totals the numbers.
Patients can also contact state health departments and find the process for reporting adverse events and hospital acquired infections. Patients can also contact the hospital licensing division (responsible for compliance with state laws) of the state which will conduct investigation and issue reports.
If you have issues with denial of service, which you are entitled to, or payment related issues, you can file an appeal at Medicare Claims & Appeals.
CMS and The Joint CommissionCMS: If you are under Medicare, then complaints can be filed with QIO (Quality Improvement Organization) of your safety. These organizations are mandated by Medicare to address complaints dealing with the care provided. You can click here or call 1-800-MEDICARE to know your QIO. Patients or their advocates can visit the CMS Beneficiary Ombudsman website for information regarding their rights.
You can call 1-800-MEDICARE for clarifications regarding billing questions. While making the call, keep in hand important details like when you were admitted, the total amount, name of the hospital and doctor. While this might not result in quick resolutions, it still puts the hospital on notice.
The Joint Commission: The Joint Commission or JCAHO (Joint Commission on Accreditation of Health Care Organizations) is a private, non-profit group that acts as federal accrediting organization for many hospitals in the US. The Joint Commission can review the quality of care complaints but cannot act against financial issues or hospital billing.
If you end up getting an infection or are dissatisfied with the medication given, you can file a complaint with the Joint Commission, that certifies and oversees the security and safety practices of US hospitals. You can write an email to The Joint Commission about your complaint. Ensure that your complaint contains the complete name and address of the concerned hospital, along with a detailed account of your complaint. Those desirous of talking about their grievances can call (800) 994-6610. Please note that oral complaints are not accepted by The Joint Commission.