Proposed CMS Rule Expands Patients' Rights to Complain

Ambulatory surgery centers must notify Medicare patients of their rights to contact the federal government with concerns about the quality of care they receive if a new rule proposed by the Centers for Medicare & Medicaid Services becomes finalized in the coming months.

Currently, only Medicare beneficiaries who are admitted to hospitals as inpatients receive information about issuing formal complaints. The proposed rule aims to expand the notification requirement beyond the hospital setting.

According to the rule, ASCs wishing to remain Medicare certified would have to inform patients in writing that they're entitled to voice complaints to the Medicare Quality Improvement Organization and note how they can contact the organization's local offices. The QIO investigates care-related complaints filed by Medicare beneficiaries and recommends steps for facilities to improve the quality of care they provide.

"Today's proposed rule would ensure that beneficiaries know they have a voice in the care they receive under the Medicare program," says CMS Administrator Donald Berwick, MD. "By requiring providers and suppliers to furnish QIO contact information to all beneficiaries, we are protecting (their) rights to bring worries about quality of care to a third party for review."

Dr. Berwick believes the proposed rule will empower more Medicare patients to report correctable issues that will improve the quality of care for all patients across many healthcare settings, where providers might not be aware of problems that need to be addressed. "By speaking up," he says, "beneficiaries can help other patients escape the same poor outcomes they have experienced."

CMS is accepting comments on the proposed notification changes until April 3 before issuing a final rule shortly thereafter.

Daniel Cook