Hospitals and health care providers who participate in the Medicare and Medicaid programs are bound by strict rules. One of these rules calls for hospitals and health care providers to abide by a set of patients’ rights approved August 2, 1999 by the federal agency that oversees the Medicare program called the Center for Medicare & Medicaid Services (CMS). This set of patients’ rights was revised on December 8, 2006. It is important for patients to understand their rights in order to exercise them when using any health care service.
Q: Exactly what rights do patients have under this CMS rule?
A: The CMS rule outlines a number of patient rights, including the right to:
1. be informed of one’s health status;
2. develop and participate in one’s plan of care;
3. request or refuse treatment;
4. complete advance directives (living will and health care power of attorney) and to have the medical and hospital staff respect those directives;
5. have the patient’s own physician and family members notified of one’s admission to a hospital;
6. personal privacy;
7. receive care in a safe setting;
8. be free from all forms of abuse;
9. confidentiality of one’s medical records;
10. access information from one’s medical record; and
11. an explanation of the reason for use of a physical or chemical (drug) restraint
Q: What should I do if I feel my rights as a patient have been violated?
A: Hospitals and other health care providers that participate in Medicare and Medicaid programs must tell patients who they should contact to file a grievance. In addition, they must establish a process to promptly resolve patient grievances. The board of trustees or directors of the health care facility must approve an effective grievance process, and must review and resolve all grievances unless this responsibility is delegated, in writing, to a grievance committee. When grievances are delegated to a committee, the board must ensure that the committee does, indeed, resolve all grievances.
Q: What are some of the quality-of-care complaints that patients report?
A: Examples of quality-of-care concerns include:
• being given the wrong medication or medications that interact in a negative way;
• not receiving treatment following abnormal test results;
• being given the wrong blood type after a transfusion has been ordered;
• sustaining a serious injury resulting from a fall while in a nursing facility or
• not receiving needed treatment due to being improperly evaluated for a medical
• receiving the wrong treatment or unnecessary treatment;
• developing bed sores due to poor skin care while in a health care facility;
• being restrained physically or through the use of chemicals in a health care facility.
Q: What happens if the grievance is not resolved?
A: If a grievance is not addressed or resolved by the healthcare facility, the patient may contact Medicare by calling the Ohio KePRO Medicare Beneficiary Helpline at 800-589-7337. The helpline is open Monday through Friday from 8 a.m. to 4:30 p.m. Should you want to file a written complaint, you may locate a form at KePRO’s Web site: www.ohiokepro.com/bene/medbenehelpline.aspx.
The helpline handles calls relating to the quality of healthcare services received and requests for Ohio KePRO materials. All other callers are directed to the appropriate Medicare office. There is also a 24-hour nationwide hotline available at (800) MEDICARE (800-633-4227). Before calling the helpline, have this information handy:
• name on Medicare card;
• Medicare number;
• phone number;
• date of birth;
• name, address and phone number for health care provider;
• date of service provided.
Law You Can Use is a weekly consumer legal information column provided by the Ohio State Bar Association. This article was prepared by Renee Mallett, Esq., Director of Patient Safety at The Ohio State University Medical Center.