Proposal requires Medicare providers to advise members of right to file quality complaints

The Centers for Medicare & Medicaid Services has issued a proposed rule that would require most Medicare-participating providers and suppliers to give Medicare beneficiaries written notice about their right to contact a Medicare Quality Improvement Organization with concerns about the quality of care they receive.

The rule would mark an expansion of the conditions under which providers would need to provide such notice to patients. Currently, only beneficiaries admitted to hospitals as inpatients are required to receive information about contacting their state QIO regarding quality of care issues.

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"Today's proposed rule would ensure that beneficiaries know they have a voice in the care they receive under the Medicare program," said CMS Administrator Donald Berwick, MD. "By requiring providers and suppliers to furnish QIO contact information to all beneficiaries, we are protecting beneficiaries' rights to bring their worries about quality of care to a third party for review, which can lead to better care not only for the beneficiary, but for all patients in a given care setting."

Under the proposed rule, providers and suppliers would need to inform beneficiaries of their right to complain to a QIO about quality of care, as well as how to contact their local QIO in order to participate in the Medicare program.

Care settings that will be impacted by the rule include:

• Clinics, rehabilitation agencies and public health agencies that provide outpatient physical therapy and speech-language-pathology services;
• Comprehensive outpatient rehabilitation facilities;
• Critical-access hospitals;
• Home health agencies;
• Hospices;
• Hospitals;
• Long-term care facilities;
• Ambulatory surgical centers;
• Portable x-ray services; and
• Rural health clinics and Federally Qualified Health Centers.

Medicare QIOs, which are predominantly private, non-profit organizations, are located in every state, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. Each QIO is staffed by doctors and other healthcare professionals who are trained to review medical care and help beneficiaries with complaints about the quality of care they receive. QIO staff also work directly with providers and facilities to make improvements in quality across all care settings.

The QIOs' role is to respond to and investigate complaints, gather facts from all parties involved and recommend action to help providers and suppliers improve quality of care.

"Medicare beneficiary complaints are an important source of information that QIOs use to improve the quality of care for all patients," said Berwick. "Sometimes providers themselves are unaware of problems or the reasons for these problems until a beneficiary shows the courage to speak up and report the issue to a QIO. By speaking up, beneficiaries can help other patients escape the same poor outcomes they have experienced."

CMS will accept comments on the proposed rule until April 3.