Attention ESRD Providers
 
 
 
 
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 a grievance is filed with 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:
  • Facilitator
  • Expert Investigator
  • Educator
  • Quality Improvement Specialist
  • Advocate
  • 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.
 
Patient Grievances
 
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.
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.
Please note that facilities will be contacted by phone and/or in writing once a grievance has been filed with the Network. The facility will be required to provide records as requested within the time frame outlined by the Network. Recommendations for quality improvement efforts will be made once all issues have been investigated. The Network will guide the facility through all quality improvement efforts and will continue to provide support and follow up as deemed necessary. The Network shares facility 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, facilities must 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).
 
 
Network Complaint and Grievance Poster – A poster sent to each dialysis and transplant center in Network 16 to post in their patient waiting areas, in English and Spanish.
 
 
 
Page modified December 29, 2017.