Show #393 Airing Sunday, 7/1/07
Just because you're a patient doesn't mean you give up your rights to question questionable health care in a hospital or nursing home. You do have options. Here to explain your rights is Jennifer Bitterman, review director at Ohio KePRO.
Question: Do hospital or nursing home patients have any legal rights?
Answer:Yes, absolutely. And these rights include:
- The right to be admitted to the hospital if it is medically necessary.
- The right to stay in the hospital until it is medically safe for you to leave.
- And the right to good, quality healthcare.
Question: hat can you do if you feel your rights are being violates?
Answer:If you are on Medicare and 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.
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 our organization, Ohio KePRO.
Question: What is Ohio KePRO
Answer:Ohio KePRO is a Quality Improvement Organization. We are a Medicare contractor that focuses on ensuring that a Medicare 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: What does Ohio KePRO do when a patient has a quality of care complaint?
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 Ohio KePRO determines that your care has not been adequate?
Answer:In most cases, and depending upon the severity of the inadequacy, Ohio KePRO will work with the provider to educate them on proper care, or serve as a mediator between the provider and the patient.
Question: What if healthcare services are going to be discontinued, or you are going to be discharged from a facility immediately?
Answer:If service is being discontinued or if 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 want to file a complaint. Sometimes you receive this information upon admission, so look through what you've been given. Contact Ohio KePRO for assistance immediately.
In most instances, Medicare will cover your care while your case is under review. If Medicare decides that you do need continued care, they will continue to cover your treatment. All this will be covered in the initial phone call you make to Medicare.
Question: Can Ohio KePRO assist if you're being denied services or hospital admission?
Answer:Yes, we can. If you are being denied admission, you will have to ask for such a notice of this denial.
Question: Where can we learn more?
Answer:You can call Medicare, or you can call Ohio KePRO to receive this free brochure.
If you have a complaint or concern about your healthcare, let Ohio KePRO know about it. They are there to help. Call them for more information, or to receive this free brochure. My thanks to Jennifer Bitterman.
