John Falcetano (john.falcetano@brooksrehab.org) is Director Corporate Compliance at Brooks Health System in Jacksonville, FL.
In this issue, we will discuss monitoring patient complaints related to compliance issues, an area that is frequently overlooked by compliance professionals. A patient can voice a concern related to many different compliance-related topics. For instance, a patient may voice a concern related to a potential privacy violation that a healthcare employee inappropriately disclosed their protected patient health information (PHI) to an unauthorized individual. A patient may be complaining about the bill they received for services they say were never provided. Patients may also report a complaint related to fraud, waste, or abuse.
Some compliance professionals may call the question, “Are you saying compliance professionals are responsible for monitoring patient complaints?” The answer should be yes, if they are related to compliance concerns. The compliance professional should be investigating and monitoring any patient complaints related to compliance. To do that, the compliance professional must first determine what system the organization uses to handle patient complaints. Is there a centralized process to handle patient complaints or is it handled in a decentralized manner? Does the organization use patient representatives to assist in providing information related to patient complaints in order to allow many minor complaints to be resolved quickly? If an organization is not using patient representatives, how are they dealing with patient complaints? Does the organization monitor patient complaints?
Complaints focus on a wide range of issues, from disliking a meal, to issues that have caused actual patient harm. It is important that patient complaints and grievances be centralized for tracking and trending, which can help organizations identify issues that require attention. Once identified, management can implement appropriate action to resolve the concern. Organizations monitor patient complaints in an effort to improve the quality of the services they provide.
In conclusion, compliance professionals must monitor patient complaints related to compliance and identify areas that may require additional regulatory training, take corrective action, and assist organizations in maintaining regulatory compliance.