Administrative Memos

200202

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 02, 2002
SUBJECT: Beneficiary Complaints - 5th Scope of Work Data Released by The Center for Medicare/Medicaid Services (CMS)
IPRO CONTACTS:

Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, Extension 364

Background

As a Quality Improvement Organization (QIO), IPRO is required to review all written quality of care/service complaints submitted by Medicare beneficiaries or their designated representatives. The review addresses whether the care/services met professionally recognized standards of healthcare. The review may also include a determination as to whether services were or were not provided in the appropriate setting. Complaints are not limited to care/services rendered in the inpatient settings. QIOs review beneficiary complaints in regard to quality of care received in:

Ambulatory surgical centers (ASCs);
Comprehensive outpatient rehabilitation facilities (CORFs);
Emergency rooms (ERs);
Home health agencies (HHAs);
Hospices;
Hospital outpatient areas (HOPAs);
Inpatient hospitals/units;
Outpatient physical therapy and speech/language pathology services;
Critical Access Hospitals (CAHs);
Skilled nursing facilities (SNFs);
Swing beds;
Specialty hospitals (e.g., psychiatric and rehabilitation);
Physicians' offices; and
Community mental health facilities (CMHFs).

Under the 5th Scope of Work (SOW), data on beneficiary complaints were collected by CMS from all QIO's. The national findings, which follow, were shared with IPRO by CMS and presents data from all (53) QIO's for cases completed during the 5th SOW. Because QIO contracts are renewed and implemented in three rounds, on a staggered basis, beneficiary complaint data ranges from the earliest 5th SOW start date of April, 1996 to the latest 5th SOW end date of February, 2000.

National Findings