Grievances and Complaints: Ensuring Compliance with the CMS and OCR Requirements (W5031)-Grievances and Complaints 2025 Recording

Video Transcription

Video Summary

Laura Dixon, an expert in patient safety and risk management, delivers an in-depth presentation on handling patient grievances and complaints within healthcare facilities, emphasizing compliance with CMS regulations to avoid serious consequences such as loss of Medicare/Medicaid funding and hospital closures. She explains the importance of recognizing and addressing grievances promptly, documenting processes thoroughly, and responding effectively within regulatory timeframes, typically seven days, to prevent deficiencies during surveys.<br /><br />Dixon details key CMS requirements: informing patients and their representatives of their rights at admission and throughout care, providing clear grievance procedures, and ensuring accessibility to state hotlines and Quality Improvement Organizations (QIO). She clarifies which facilities these rules apply to, noting that while critical access hospitals aren't explicitly regulated on grievances, they should maintain policies consistent with acute care standards to manage complaints effectively.<br /><br />The presentation underscores the necessity of a grievance committee, ideally multidisciplinary, overseen by the governing board, to review all grievances and integrate findings into Quality Assurance Performance Improvement (QAPI) initiatives. Dixon stresses proper documentation, appropriate response wording (avoiding legal terms like "standard of care"), and the balance between timely investigation and patient communication, including the challenges of sharing contact details of grievance responders due to privacy and safety concerns.<br /><br />Additionally, Dixon covers anti-discrimination requirements under the Affordable Care Act’s Office of Civil Rights Section 1557, focusing on non-discrimination based on protected classes and ensuring qualified interpreter services for patients with limited English proficiency.<br /><br />Through case examples and Q&A, the session highlights practical strategies for complaint resolution, legal considerations, patient rights communication, and the crucial role of hospital staff and leadership in maintaining compliance and fostering patient trust. Resources and templates are provided to support implementation of effective grievance management programs.

Keywords

patient safety

risk management

patient grievances

CMS regulations

Medicare Medicaid funding

hospital closures

grievance procedures

Quality Improvement Organizations

grievance committee

Quality Assurance Performance Improvement

Affordable Care Act Section 1557