Highlight Consumer Rights, Protections, and Ways To Complain

A report on health care quality is an ideal place to remind consumers and patients of their rights and protections. In addition to having direct practical value, it reinforces two key messages inherent in public reporting:

  • Consumers and patients have a right to seek out high-quality care.
  • They can take action to protect themselves.

The specific rights and protections to highlight will vary depending on the kind of organizations being rated. If you are rating health plans, for example, it will be important to stress member’s rights to appeal decisions about getting services covered, their rights to change their physician within the plan’s network, and their rights to complain both formally and informally.

Where To Complain

Most consumers are not aware that every State has organizations with systems to gather complaints about bad quality care or the inappropriate behavior of a physician or other provider. You can help raise awareness by listing names and contact information for the organizations in your State or community that take responsibility for complaints about the health plans or providers covered by your ratings.

Caveats:

  • It takes careful research to ensure you are including all of the agencies that can help.
  • The landscape changes often. For example, in the next few years, we may see systems that enable patients to report on adverse events, including near misses.

Protections for Seniors

Because older people and those with long-term disabilities use a great deal of health care, it is especially important to explain how people with Medicare can protect their interests. The two principal options include:

  • Complaining to the federally supported Quality Improvement Organization (QIO) in your State about health care quality problems. (A list of QIOs is available at: http://www.qioprogram.org/contact.
  • Seeking assistance from the State Health Insurance Information Program (SHIP) Agency in your State or locality if you have problems with your Medicare benefits, including Medicare Advantage plans. (Contact information for SHIP programs is available at: http://www.shiptacenter.org/.)

How To Complain

Your report can also include information on how to register complaints, appeals, and grievances. The goal is to demystify the process so people feel comfortable going forward.

For example, you can explain:

  • What kinds of problems constitute legitimate complaints (and which do not).
  • How to file a complaint or appeal with a health care organization.
  • When to take your concern to the next level.
  • Whom to contact for different kinds of concerns.
  • What kind of response to expect.

EXAMPLE: Offering Guidance on How To Complain About Hospitals

Title: Maryland Health Care Quality Reports: Need to File a Complaint?
Sponsor: Maryland Health Care Commission
URL: https://www.marylandqmdc.org/Article/View/6201a930-70a8-4cce-9759-c3f2d4fd41f7?Type=Need%20to%20file%20a%20complaint%3F

Maryland Health Care Commission’s Health Care Quality Reports provide clear guidance to consumers on making a formal complaint if they or their loved ones have experienced a problem with the care provided by a health care provider in Maryland.

Source: Maryland Health Care Commission. Maryland Health Care Quality Reports. Available at  https://www.marylandqmdc.org/?Type=Home.

 


Also in "Taking Advantage of the ‘Teachable Moment’"

Page last reviewed June 2016
Page originally created February 2015
Internet Citation: Highlight Consumer Rights, Protections, and Ways To Complain. Content last reviewed June 2016. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/talkingquality/explain/share-info/highlight.html
Back To Top