Show #410 Airing Sunday 12/2/07
We all know, if you see a ghost, who you gonna call? Ghostbusters! But what if you see poor care in a hospital or nursing home? Who can you call? Ohio has its very own team of Medicare problem solvers called Ohio KePRO. And they make sure your legal rights to quality care are not just an apparition. Here to explain is Jennifer Bitterman, review director of Ohio KePRO.
Question: People might be surprised to learn that Medicare laws give hospital and nursing home patients important legal rights.
Answer: That's right, Armond. Medicare beneficiaries have:
- 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.
This information is in the 'Know your Rights' kit that we want viewers and all Ohioans to have. It explains that Ohio KePRO will perform a quality of care review and an appropriateness of discharge review.
Question: Are there definitions? What's it mean to be "medically safe" to leave a hospital? And what does the right to "good quality health care mean'?
Answer: "Medically safe" to leave the hospital means that a physician feels that your medical condition is either resolved or should be treated in another setting. For example, perhaps you're ready for rehab in a skilled nursing facility or by home health care.
"Good quality health care" means you're receiving medically accepted standards of care, at the right time, every time.
Your rights are based on concerns you might have like:
- Being given the wrong medication or medications that interact in a negative way.
- Sustaining a serious injury while in a nursing home or hospital.
- Being improperly evaluated for a problem and because of this you did not receive the treatment you needed.
Question: What can you do if you feel your rights or those of a family member are being violated?
Answer: 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 can call us at Ohio KePRO at 800.589.7337.
However if you have other Medicare concerns such as billing, call 1-800-MEDICARE.
For quality of life issues such as cold food, you should call the state ombudsman office.
Question: What is Ohio KePRO?
Answer: Ohio KePRO is a Quality Improvement Organization. Every state has one, and we are the Medicare contractor for Ohio that focuses on ensuring that a Medicare patient gets the right care at the right time, every time.
We work with healthcare providers and beneficiaries 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.
If you'd like help talking with your provider about your care, you can call us and we can help facilitate the conversation.
Question: What does Ohio KePRO do concerning patient complaints?
Answer: We will ask the patient some basic information such as dates of service and the healthcare provider. We will then ask the provider for a copy of the complainant's healthcare records. We have [non biased] 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: The purpose of a quality of care review is to find the reason why things happened to cause your concern and to determine the likelihood that it will happen again. The purpose of a quality of care review is not to punish your doctor, but to help improve care delivery for patients. In cases where chances are high that the scenario will happen again, the Ohio KePRO Review Team will help your healthcare provider make changes in procedures to prevent future problems. This can relate to improving provider and patient communications/understanding to changing the procedure of how medications are administered to ensure they are given to the right patient.
Question: What if Ohio KePRO determines that you are not ready for discharge?
Answer: 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. If it decides you do not, your care during the review is still covered.
Question: Is there any cost to these reviews?
Answer: No. It's a free service that's part of your Medicare rights.
Question: Where can we learn more?
Answer: Like I mentioned earlier, we have the 'Know Your Rights Kit' that we can send you for free that can explain case review.
You may not need Ohio KePRO's services today, but you may need this information for you or someone you love tomorrow.
If you have a complaint or concern about your healthcare, Ohio KePRO is there to help. For more information, call the number that's next to receive a free brochure. My thanks to Jennifer Bitterman.
