Show #254 Airing: Sunday, May 2, 2004
Making sure patients receive the best care should be a priority for health providers. Most of the time, that goal is met. But not always. If you believe your spouse or parent is not getting the care they deserve, what can you do? Here to tell us about a new complaint process is Jennifer Bitterman, case review manager at Ohio KePro.
Question: If you have a complaint about the quality of care that you or a loved one received for healthcare that Medicare paid for, mediation is now available as a way to confront and hopefully fix the problem. What is mediation? Why can it be helpful?
Answer: Mediation is an extension of the complaint program already in existence at the Centers for Medicare and Medicaid.
The complaint process begins when a beneficiary or his/her family calls Ohio KePRO to complain about any healthcare for which they are receiving benefits. The complaint is processed by looking at the beneficiary’s medical records, a review conducted by a Board Certified Physician reviewer.
In conduction these reviews, we have found that 80% of complaints do not really have to do with actual “quality of care” issues; rather, they have to do with communication problems.
For example, sometimes a patient doesn’t understand why a certain test must be done, feeling it was excessive, etc. The doctor may not have fully explained the reasons behind the procedure being done. Another example of miscommunication happens in a nursing facility, where there may be a miscommunication about the duties of the nursing staff.
Question: What happens in mediation?
Answer: The family and the physicians meet with the mediator (a fully-trained independent contractor with Ohio KePRO).
Both sides have the opportunity to listen to the other, ask questions, etc. We’ve found that it promotes communication and education for both sides (families learn what’s happening health-wise, physicians learn how to better communicate).
Question: What if you don’t want to do mediation—is there another option?
Answer: Both the beneficiary/family and the physician must agree to mediation for it to occur.
If someone does not want to go through mediation, we revert back to the regular review process, which is paper-based—looking at the medical record, writing letters to the physicians involved, etc.
Most find, however, that the family receives a lot of additional support through face-to-face mediation, and most people who go through it find it beneficial.
Question: What kinds of complaints are most appropriate for mediation?
Answer: Things like:
- "I didn’t receive my medication.”
- “I didn’t receive the correct medication.”
- "The nurse didn’t respond when I buzzed.”
- “The facility stopped rehab or treatment too soon.”
- “The nurse didn’t keep my dad clean.”
- And lots more
Question: If a patient agrees to mediation, is he giving up any rights?
Answer: No.
Question: Do you need a lawyer at the mediation?
Answer: No. In fact, you may only bring a lawyer if the other party agrees. And the other party may only bring a lawyer if you agree. We want free discussion.
Question: Who pays for all this mediation?
Answer: Medicare.
Question: You mentioned that mediation was used in cases where there was a communication issue. What about times where quality of care really IS the concern?
Answer: Mediation is only for communication issues. If there is a real quality of care issue, the traditional complaint process ensues.
Question: What can our viewers do?
Answer: If you are a Medicare/Medicaid beneficiary, you have rights. If you have any concerns over quality of care, call our hotline to initiate the complaint process.
If you have a concern about the care a parent or a spouse is getting, don’t just accept it. Give Ohio KePro a call. Ask about mediation. This new option may not only help your loved one, but it may result in better care for others too.
