Show #337 Airing Sunday, 4/16/06
If you’re not getting proper medical care in a hospital or nursing home, do you have any legal rights? What if you’re being discharged from the hospital, but you’re not yet ready to go home. Here to tell us about patients’ rights to quality care, and how to enforce those rights, is Marti Truby, Review Supervisor for Ohio KePRO.
Question: KePRO is a Quality Improvement Organization. What does that mean?
Answer: Ohio KePRO is a Medicare contractor that focuses on ensuring that a patient gets the right care at the right time, every time. Every state has such an organization, and we are Ohio's.
We work with healthcare providers to ensure that quality care is available to patients. We look for quality improvements and make sure that best practices are being followed in healthcare settings. For example, if a nursing home were having issues with pressure ulcers, we would work with them to put into practice the best procedures to avoid such ulcers.
We also work with consumers (patients) to protect their rights and to see that opportunities for quality healthcare are available for them.
Question: You mentioned that patients have rights. What are these rights?
Answer:
- You have the right to be admitted to the hospital if it is medically necessary.
- You have the right to stay in the hospital until it is medically safe for you to leave.
- And you have the right to good, quality healthcare.
Question: What if you feel that your rights are being violated? How can you file a complaint?
Answer: If you have any concerns about your healthcare, it's best to call 1-800-Medicare. They are the clearinghouse for all comments and will help direct you to the proper agency to deal with your concern.
For example, if you need medical equipment, they will help you find those resources. If you have a Quality of Life complaint, such as cold food in a nursing home or noisy hallways, you will be directed to the ombudsman's office.
If you have a Quality of Care complaint (a medical complaint) or if you feel like you are being discharged from a healthcare facility too early, you will be directed to Ohio KePRO.
Question: What does KePRO do about such complaints?
Answer: We might ask the patient some basic information such as dates of service and the healthcare provider. However, we will ask the provider for a copy of the complainant's healthcare records. We have physician reviewers who go over the records and see whether or not the care received was appropriate.
Again, Ohio KePRO reviews complaints that are specifically medical in nature, that need a doctor's review.
Question: What if KePRO determines that you care's not adequate?
Answer: We will work with the healthcare provider to help them provide better care, and then monitor the situation.
Question: What if your healthcare services are going to be discontinued and it's a current situation? What can you do if you're going to be discharged now? Or if you're being denied admission?
Answer: If service is being discontinued/you will be discharged, you will receive, or should have received, a notice that has information on how to contact Ohio KePRO if you disagree with the decision and file a complaint. Sometimes you receive this information upon admission, so look through what you've been given.
If you are being denied admission, you will have to ask for such a notice.
But again, if there's any concern about any kind of medical issue, you can always be safe by calling 1-800-Medicare.
Don't worry yourself sick if you have a complaint about your healthcare. Ohio KePRO's mission is to ensure you have the best quality healthcare possible. For more information, or if you have a complaint or concern, call the number that's next. My thanks to Marti Truby.
