The Role of HealthInsight ESRD Network 16 in Handling Complaints and Grievances.
Patient Toll-Free Number for Northwest Renal Network: 1-800-262-1514
Network 16 is a non-profit organization funded by the Centers for Medicare & Medicaid Services (CMS). Its mission is to promote optimal dialysis and transplant care for kidney patients in Alaska, Idaho, Montana, Oregon and Washington.
One of its most important responsibilities is to serve as an unbiased, outside review agency. Patients, family members, facility staff, and others may contact the Network regarding the care provided to patients at Medicare-certified facilities.
What should you expect when contacting the Network?
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 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 care partner’s perspective. Change occurs when dialysis facilities understand the root cause(s) of the grievance issues 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:
- Expert Investigator
- Quality Improvement Specialist
- Referral Source
The Network may also take on other roles as required by the case, based on an understanding that the Network’s primary goal is to resolve the case as successfully as possible for the grievant.
Grievance: A written or oral communication from an ESRD patient, and/or individual representing an ESRD patient, and/or another party, alleging that an ESRD service received from a Medicare-certified provider did not meet the grievant’s expectations with respect to safety, civility, patient rights, and/or clinical standards of care.
If you, the grievant, have a grievance regarding ESRD treatment, you may exercise your right through the grievance process. The purpose of the grievance is to address concerns alleging that ESRD services were not provided or that they did not meet the recognized levels of care. If you would like to file a grievance you may fill out the grievance packet provided below and send it to the Network, or you may contact the Patient Services Department toll-free at (800) 637-4767.
Upon receipt of a grievance the Network shall classify the case as one of the following:
- Immediate Advocacy – Utilized for non-clinical concerns that do not require complex investigation- resolved in 7 days or less
- General Grievance – Concerns that are non-clinical in nature, but require complex investigation and records review- resolved in 60 days or less
- Clinical Quality of Care – Concerns that involve clinical or patient safety issues and require clinical record review, by an RN and/or the Medical Review Board- resolved in 60 days or less.
How do I reach the State Agency which licenses and surveys dialysis facilities?
Both Northwest Renal Network and State Survey Agencies monitor the quality of care provided to patients and investigate complaints. We have provided a list of the State Survey Agencies in our region and their contact information.
STATE SURVEY AGENCY CONTACTS
Dept. of Health & Social Services
Hotline (907) 563-0037 in Anchorage
|Idaho||Bureau of Facility Standards
Div. of Medicaid
Idaho Depart. of Health & Welfare
PO Box 83720
Boise, Idaho 83720-0036
|Phone (208) 334-6626
Fax (208) 364-1888
|Montana||Quality Assurance Division
Montana Dept. of Health &
PO Box 202953
Helena, Montana 59620-2953
Phone (406) 444-2099
Fax (406) 444-1742
PO Box 14450
Portland, Oregon 97293-0450
|Phone (971) 673-0540
Fax (971) 673-0556
|Washington||WA State Department of Health
Health Systems Quality Assurance
PO Box 47857
Olympia, Washington 98504-7857
|Hotline (800) 633-6828
Phone (360) 236-2900 ext 1
Fax (360) 236-2901
Network Grievance Brochure - https://s3-us-west-2.amazonaws.com/nwrn.org/files/Provs/nw16.GrievanceBrochure.pdf .
Page updated December 28, 2017