Description:

Healthcare institutions play a vital role in society, entrusted with the well-being of patients. Ensuring hospitals adhere to regulations and standards is crucial to maintaining the highest patient care and safety level. The webinar delves into the importance of addressing grievances and complaints to guarantee hospital compliance with the Centers for Medicare and Medicaid Services (CMS), Conditions of Participation (CoPs), Joint Commission Requirements, Det Norske Veritas (DNV) standards, and the Office for Civil Rights (OCR).

A ‘Patient Grievance’ is a formal or informal written or verbal complaint that is made to the hospital by a patient or the patient’s representatives regarding the patient’s care, issues related to the hospital’s compliance with the CMS Hospital Conditions of Participation, or a Medicare beneficiary billing complaint about rights and limitations, all these complaints should be resolved by the hospital for prompt resolution of patient grievances. They must inform each patient whom to contact to file a grievance. There is no similar section for Critical Access Hospitals, and the requirements for acute hospitals do not apply to CAHs. Those facilities should have policies and procedures to address patient rights, including any grievance or complaint.

It will also discuss the OCR Section 1557 on complaint process and recent changes, governing board responsibilities, grievance committee, survey procedure, grievance process, patient proper requirements 117, CMS memos 2014 and 2015 recognize the rights of a spouse in legally valid same-sex marriages and quality improvement organizations to make hospitals aware of the fact. Hospitals that prioritize patient concerns establish clear strategies, and continually seek improvement are better positioned to provide safe and high-quality care while meeting the demands of regulatory bodies.

Areas Covered:

• The webinar will cover CMS requirements for hospitals to comply with the grievance regulations.
• Informing each patient on how to file grievances.
• Providing suggestions to both the patient and their representative for their rights,
• Hospitals are expected to take reasonable steps to determine the patient’s wishes regarding the designation of a patient representative.
• Highlighting the significance of maintaining quality care and safety.
• The process to handle discrimination-related grievances under OCR Section 1557 and recent policy and grievance process changes.
• Briefly discuss  DNV Health NIAHO standards on grievances.
• Considering local factors that are important to beneficiaries and their families.
• Providing the responsibilities of the governing body in the grievance process.
• Maintaining a time frame for responding to grievances. 
• Patients have the right to have their concerns addressed promptly, reasonably, and consistently.
• Hospitals should have a timely process to deal with minor requests rather than written ones.
• Provide such information to representatives for incapacitated/incompetent patients. 
• Hospitals must ensure qualified interpreters are available. 
• OCR Grievance Portal has a section on how patients can file a civil rights complaint.
• TJC Complaint Standard outlines the procedures and requirements for handling and addressing patient complaints.
• State Laws can specify a procedure for determining who can be a patient representative if the patient is incapacitated.
• Hospitals must ensure LEP and health literacy.
• Conduct audits and QAPI to ensure the facility follows its grievance P&P.
• The complaint process, grievance process, interpreters, available resources, and internet links are essential components of Section 1557 compliance.
• The grievance process must include a mechanism for timely referral of patient concerns regarding the quality of care or premature discharge to the appropriate QIO. 

Why Should You Attend:

Grievance is a specific concern that is perceived to be unfair. It requires a complete understanding of the Joint Commission complaint standards and the DNV healthcare grievance requirements. The hospital must establish a process for promptly resolving patient grievances, a fundamental need for safeguarding the health and rights of patients and maintaining the integrity of healthcare institutions.

 Who Should Attend:

• Patient Advocates
• Joint Commission Coordinator
• All department directors
• Chief Executive Officer (CEO)
• Chief Operating Officer (COO)
• Chief Nursing Officer (CNO)
• Chief Medical Officer (CMO)
• Quality Improvement Coordinator
• Risk Managers
• Lab Director.
• All Nurse Educators and Managers.
• Patient Safety Officer
• Compliance Officer
• HIPAA privacy and security officer
• Policy and Procedure Committee
• Anyone involved in implementing the CMS grievance, DNV, OCR, or Joint Commission-compliant standards.

Presenter Information:

Name: Laura A. Dixon

Laura A. Dixon served as the Director, Facility Patient Safety and Risk Management, and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided patient safety and risk management consulting and training to facilities, practitioners, and staff in multiple states.

Such services included the creation of presentations on risk management topics, assessment of healthcare facilities; and development of programs and compilation of reference materials that complement physician-oriented products.

Ms. Dixon has more than twenty years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services, and pain management. Prior to joining COPIC, she served as the Director of, Western Region, Patient Safety, and Risk Management for The Doctors Company, Napa, California.

In this capacity, she provided patient safety and risk management consultation to the physicians and staff in the western United States. Ms. Dixon’s legal experience includes representation of clients for Social Security Disability Insurance providing legal counsel and representation at disability hearings and appeals, medical malpractice defense, and representation of nurses before the Colorado Board of Nursing.

As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.