The Role of the Network in Handling Grievances
The Network’s case review responsibilities include investigating and resolving grievances filed with the Network and addressing non-grievance access to care cases. CMS views the investigation and resolution of grievances and non-grievance access to care cases as an opportunity to focus on meeting the needs of ESRD patients as well as an opportunity to create change by listening to and learning from the patient’s and/or caregiver’s perspective. Change occurs when dialysis facilities understand the root cause(s) of the grievance issue and implement steps to resolve the issue(s). The steps that lead to resolution may be simple and specific to the grievant or there may be a need for a systemic change to correct the issue for the benefit of all patients within a dialysis facility.
Depending on the details of a case, the Network may assume one or more of the following roles in addressing a grievance filed by an ESRD patient, an individual representing an ESRD patient, or another party:
Quality Improvement Specialist
Upon receipt of a grievance the Network shall classify the case as one of the following:
1. Immediate Advocacy - utilized for non-clinical concerns that do not require complex investigation; resolved in 7 days or less.
2. General Grievance - concerns that are non-clinical in nature, but require complex investigation and records review; resolved in 60 days or less.
3. Clinical Quality of Care - concerns that involve clinical or patient safety issues and requires clinical record review, by an RN and/or, the Medical Review Board; resolved in 60 days or less.
Please note that you will be contacted via phone and/or in writing once a grievance has been filed with the Network. You will be required to provide records as requested within the time frame outlined by the Network. Recommendations for quality improvement efforts will b made once all issues have been investigated. The Network will guide you through all quality improvement efforts and will continue to provide support and follow-up as deemed necessary. We share your goals to ensure that all care provided to the patients in our service area is of the highest quality possible.
As required by the conditions for coverage, please ensure that all patients are educated on the grievance process and the various options when filing a grievance by providing ongoing individualized education as well as displaying the Network poster in a common area that patients and visitors have access to (such as the unit lobby).
Grievance Poster Georgia (English|Spanish)
Grievance Poster North Carolina (English|Spanish)
Grievance Poster South Carolina (English|Spanish)
Grievance Process Guide
Patient Grievance Process Guide Brochure
Managing Retaliation for Staff
Patient Grievance Toolkit
DON'T MISS A MINUTE Flyer
Mental Health of Dialysis Patients Toolkit (NC|SC|GA)