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New Medicare Rule Informs Beneficiaries Of Their Right To Complain

Medicare has proposed a new rule that would require most medical care providers and suppliers to notifiy Medicare beneficiaries of their right to file a complaint about the quality of care they receive.

Under current rules, only beneficiaries admitted to hospitals as inpatients are required to receive information about contacting their state Quality Improvement Organization (QIO) regarding quality of care issues. The proposed rule from the Centers for Medicare & Medicaid
Services would require that in order to participate in the Medicare program, providers and suppliers would need to inform beneficiaries of their right to complain to a QIO about quality of care, as well as how to contact their local QIO.

“Today’s proposed rule would ensure that beneficiaries know they have a voice in the care they receive under the Medicare program,” said CMS Administrator Dr. Donald Berwick, in a press release. “By requiring providers and suppliers to furnish QIO contact information to all
beneficiaries, we are protecting beneficiaries’ rights to bring their worries about quality of care to a third party for review, which can lead to better care not only for the beneficiary, but for all patients in a given care setting.”

The new proposal would impact the following health care settings: Clinics, rehabilitation agencies, and public health agencies that provide outpatient physical therapy and speech-language-pathology services
Comprehensive outpatient rehabilitation facilities
Critical access hospitals
Home health agencies
Hospices
Hospitals
Long-term care facilities
Ambulatory surgical centers
Portable X-ray services
Rural health clinics and Federally Qualified Health Centers

One of the key tools QIOs use to improve quality of care is responding to complaints from Medicare beneficiaries regarding the care they receive from Medicare-participating providers and suppliers. QIOs investigate these complaints, gather facts from all parties involved,
and recommend action to help providers and suppliers improve quality of care.

“Medicare beneficiary complaints are an important source of information that QIOs use to improve the quality of care for all patients,” said Dr. Berwick. “Sometimes providers themselves are unaware of problems or the reasons for these problems until a beneficiary shows the courage to ‘speak up’ and report the issue to a QIO. By speaking up, beneficiaries can help other patients escape the same poor outcomes they have experienced.”

CMS will accept comments on the proposed rule until April 3, 2011 and will respond to comments in a final rule to be issued in the coming months.

For more on quality of medical care issues, see the medical malpractice library of articles by Daytona Beach medical malpractice attorney.





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