In 2010, Hospitals Must Take Patient Complaints Seriously

Both The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) require hospitals to arm patients and families with specific instructions about how to register complaints. These expectations have likely increased the volume of complaints processed over the last year. But, even more importantly, subtle changes in the content of complaints may pose a challenge for hospitals in 2010, particularly if the impact of these complaints is underestimated.

In recent years, increased media attention on “Never Events” and the prevalence of information on the Internet have made patients and families more informed and more keenly focused on quality of clinical care. Simple complaints of rude behavior and cold food have been replaced with reports of unmet pain needs, poor quality of care, and delays in service. These precise, care-related complaints and grievances can have regulatory implications beyond monitoring of patient satisfaction.

Processing complaints and grievances within the required timeframes
(7 days) can be challenging as volumes increase. CMS Patient Rights standards require that hospitals present to all patients who submit a grievance a response that includes the minimum items outlined in the standard. The items include:

• Written notice of hospital’s decision
• Name of the hospital contact person
• Steps taken on behalf of the patient to investigate the grievance
• Results of grievance process
• Date of completion

Of course, not all grievances can be resolved within a 7-day timeframe. In those cases, patients who have submitted grievances should receive acknowledgment of the grievance and an indication of what follow-up to expect. A second letter should outline what was done on behalf of the patient to resolve the grievance.

Failure to resolve grievances in a timely manner can result in findings during a CMS review. Furthermore, when specific complaints from informed patients and families reveal gaps in nursing care, medication errors, poor infection prevention or hints of patient rights violations, CMS and the states are compelled to investigate the validity of those complaints. Thus, an increasing number of hospitals are receiving CMS complaint surveys directly related to complaints from patients and families. When surveyors can substantiate these complaints based on more detailed information provided from families, the number of condition- and standard-level violations increases, bringing more hospitals close to Immediate Jeopardy and even Medicare Termination. (For more information about how patient complaints can lead to Immediate Jeopardy citations, check out this recent article from Medicaid Compliance News.)

Visits by CMS and state surveyors to investigate simple complaints are nothing new, of course. The current danger lies in hospitals’ temptation to dismiss these visits as “routine.” As more information funnels from patients and families to the surveyors, complaints become easier to substantiate. What’s more, healthcare reform and the increased demand for higher quality healthcare are expected to result in better funding for CMS and states, specifically to monitor the quality of care provided to Medicare recipients. Such a scenario would almost surely result in more in-depth and more frequent surveys.

Organizations that fail to fully address complaints when they can be quickly mitigated will likely place themselves at greater risk for findings during CMS survey. It is anticipated that hospitals will see a rise in Immediate Jeopardy citations and Medicare Termination this year. The bottom line? Take complaints seriously in 2010!