What Is A Grievance?
When contacting the Network, it is important to know that few contacts are actually considered grievances. Instead, there are three types of contacts: inquiries, concerns and grievances.
1.) Inquiries are questions which seek specific information.
2.) Concerns are more involved contacts that may have to do with dissatisfaction with treatment, other events, facility staff or the physical environment of the unit.
3.) A Grievance is a documented (written) concern alleging ESRD services provided did not meet the professionally recognized levels of care or ESRD services were not provided.
In the case of grievances, there is a request by the contact person for a formal grievance review. The Network then determines whether the concern can be addressed and resolved without a formal review. If the contact is determined to be a grievance, the Network will review and evaluate the information. A neutral committee may also participate in the review. Resolution is the goal of the neutral party.
A concern on the other hand, can frequently be handled through improved communication and by bringing the two involved parties together. The Network is a facilitator of communication. Our goal is to bring people together to find a resolution.
Role of the Network
ESRD Network 4 is dedicated to the delivery of quality patient care. We recognize the need for policies and procedures to address patient grievances concerning the care and conditions in an ESRD facility, without fear of discrimination or punishment at the facility level. The Network's role in the processing of patient grievances is as a facilitator. The purpose of the grievance policy is to:
- Maintain open communications between dialysis patients and staff with regard to inquiries, concerns or grievances;
- Bring the appropriate people together to facilitate a resolution as quickly as possible;
- Help patients feel comfortable when reporting their concerns without fear of mistreatment or retaliation;
- Allow patients to remain anonymous and their cases confidential (patients will be asked if when speaking with the facility their identity can be revealed);
- Assist patients through the grievance process.
Suggested Guidelines for Contacting the Network
These are suggested guidelines to follow when contacting the Network about an inquiry, concern or grievance:
- If you have made your initial contact with the Network by phone, please confirm your concern in writing. This provides us with documentation of the problem in your words. Specifics such as names, dates, and unit location help to clarify the issue. All concerns are explored after the initial contact; however, a written contact contains more evidence in order to classify it as a grievance.
- Though Network 4 prefers to work with you directly, you may choose anyone as your representative. You must complete and sign a form to designate that person to act on your behalf.
- You may request assistance from the Patient Services Coordinator via phone, email, fax or letter. You can withdraw a grievance at any time.
We recommend you ask about and explore you dialysis faciliy's grievance procedure before contacting the Network. Communication with facility staff will help you properly address your concerns.
Determination of Network Involvement
Networks may only become involved in the resolution process of a patient concern where the patient is a Medicare eligible beneficiary and a Medicare-certified provider or supplier provides the services. Medicare eligible beneficiaries could include patients entitled to both Medicare and the Department of Veterans Affairs benefits.
The exception to this guideline is that a Network may investigate a concern from other than a Medicare patient if, in the Network's belief, the nature of the grievance could impact on the general care provided by a Medicare approved facility and thus affect Medicare patients.
If the grievance received by the Network appears to present an immediate and serious threat to patient health and safety, the Network will begin its investigation. The grievance will be forwarded immediately to the Associate Regional Administrator, Division of Health Standards and Quality at the appropriate Centers for Medicare & Medicaid Services Regional Office and State Survey Agency.
A concern which deals with reimbursement or which concerns Medicare requirements for participation in the ESRD Program will be referred to the appropriate agency (e.g. Blue Cross/Blue Shield or Medicare). The Network cannot address issues dealing with money, payment of bills, or State/Federal licensure or Certification.
A concern which deals with transportation will be referred back to the transportation agency or those who arrange your transportation.
ESRD Network 4 does not provide legal advice, cannot hire or fire staff, and cannot assign dialysis facilities to patients or force a facility to accept a patient.
Response of the Network
ESRD Network 4 emphasizes problem solving between the two parties as the more effective way to resolve concerns. Patients are urged to attempt to settle their concerns with the facility staff before contacting the Network. If you believe care or facility conditions do not meet quality standards, you are encouraged to contact your medical director, nurse manager, administrator or social worker.
The Network will intervene and assist in addressing a concern when you are uncomfortable in first discussing the concern at the facility level or when you believe the concern was not handled satisfactorily at the facility level.
When we receive your call or letter, we will:
- Ask if you want to remain anonymous. A patient's identity is confidential and cannot be revealed without permission.
- Inform you if it is not possible to pursue your concern without revealing your identity.
- Respond by phone or in writing if we determine that the problem is not a Network issue, or can be more appropriately handled by another agency.
- Send a written acknowledgement of a formal grievance within fifteen (15) business days including any actions taken as a result of your contact.
- Conclude our mediation/resolution activities within ninety (90) days of receipt of your concern and provide a summarized written response (unless the resolution activities need further review or are assigned to a neutral grievance subcommittee).
It is suggested that all patients familiarize themselves with the policies and procedures of their own dialysis unit, including the "Zero Tolerance Policy" (if applicable). Knowing and communicating the consequences of certain behaviors or actions within the unit can help your unit maintain an environment of open communication.
