A “patient grievance” is a written or verbal complaint (when the verbal complaint about patient care is not resolved at the time of the complaint by staff present) by a patient, or the patient’s representative, regarding the patient’s care, abuse or neglect, issues related to the hospital’s compliance with the CM, or a Medicare billing complaint related to rights and limitations.
• If a verbal patient care complaint cannot be resolved at the time of the complaint by staff present, is postponed for later resolution, is referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution, then the complaint is a grievance for the purposes of these requirements. A complaint is considered resolved when the patient is satisfied with the actions taken on their behalf.
• Billing issues are not usually considered grievances for the purposes of these requirements. However, a Medicare beneficiary billing complaint related to rights and limitations are considered a grievance.
• A written complaint is always considered a grievance, whether from an inpatient, outpatient, released/discharged patient or their representative regarding the patient care provided, abuse or neglect, or the hospital’s compliance with CoPs. For the purposes of this requirement an Email or fax is considered “written”.
• Information obtained with patient satisfaction surveys does not usually meet the definition of a grievance. If an identified patient writes or attaches a written complaint on the survey and requests resolution, then the complaint meets the definition of a grievance. If an identified patient writes or attaches a complaint to the survey but has not requested resolution, the hospital must treat this as a grievance if the hospital would usually treat such a complaint as a grievance.
• All verbal or written complaints regarding abuse, neglect, patient harm or hospital compliance with CMS requirements, are to be considered a grievance for the purposes of these requirements.
• Whenever the patient or the patient’s representative requests their complaint be handled as a formal complaint or grievance or when the patient requests a response from the hospital, then the complaint is a grievance and all the requirements apply.
The hospital’s grievance process must be approved by its governing body. The governing body is responsible for the effective operation of the grievance process, which includes the hospital’s compliance with all the CMS grievance process requirements. The governing body must review and resolve grievances, unless it delegates this responsibility in writing to a grievance committee. A committee is more than one person. The committee membership have adequate numbers of qualified members to review and resolve the grievances.
If the grievance will not be resolved, or if the investigation is not or will not be completed within 7 days, the hospital should inform the patient or the patient’s representative that the hospital is still working to resolve the grievance and that the hospital will follow-up with a written response within a stated number of days in accordance with each hospital’s grievance policy. The hospital must attempt to resolve all grievances as soon as possible On average, for most months does the hospital provide a written response to most of its grievances within 7 days?
When a patient communicates a grievance to the hospital 0r IIWMTA via email the hospital may provide its response via email pursuant to hospital policy. (Some hospitals have policies against communicating to patients over email.) If the patient requests a response via email, the hospital may respond via email. In these circumstances and when the email response contains the information stated in this requirement, the email meets the requirement for a written response.The hospital must maintain evidence of its compliance with these requirements.
A grievance is considered resolved when the patient is satisfied with the actions taken on their behalf.There may be situations where the hospital has taken appropriate and reasonable actions on the patient’s behalf in order to resolve the patient’s grievance and the patient or the patient’s representative remains unsatisfied with the hospital’s actions. In these situations the hospital may consider the grievance closed for the purposes of these requirements. The hospital must maintain documentation of its efforts and demonstrate compliance with CMS requirements.
In its written response, the hospital is not required to include statements that could be used in a legal action against the hospital, but the hospital must provide adequate information to address each item stated in this requirement. The hospital is not required to provide an exhaustive explanation of every action the hospital has taken to investigate the grievance, resolve the grievance or other actions taken by the hospital.
In accordance with State law and hospital policy, a dietitian may assess a patient’s nutritional needs and provide recommendations or consultations for patients but the patient’s diet must be prescribed by the practitioner responsible for the patient’s care.