​A risk manager recently asked whether the Centers for Medicare and Medicaid Services (CMS) requires that a physician's office respond to patient complaints in writing. In our response, we noted that although a written response to complaints is not required by regulation for physician practices, good risk management and quality of care practices are to take patient complaints seriously.

Our response distinguished between a “patient complaint" and a “patient grievance," as defined by CMS.

According to CMS interpretive guidance, a grievance “is a formal or informal written or verbal complaint that is made to the hospital by a patient, or the patient's representative, regarding the patient's care (when the complaint is not resolved at the time of the complaint by staff present), abuse or neglect, issues related to the hospital's compliance with the CMS . . . CoPs [Conditions of Participation], or a Medicare beneficiary billing complaint related to rights and limitations provided by 42 CFR 489 [provider agreements and supplier approval]."

A patient “complaint" is a broader term that could encompass a host of issues and concerns other than that captured in the CMS definition.

It appears that CMS's CoPs do not require a private physician office to respond to patient “complaints" in writing, nor do they require a private physician office to respond in writing to a patient grievance. Federal regulations, at 42 CFR 489.2, address the scope of providers subject to the provisions and limitations of Medicare provider agreements that would include CMS patients' rights and grievances. The following nine types of providers are subject to the provisions of this part:

• Hospitals
• Skilled nursing facilities
• Home health agencies
• Clinics, rehabilitation agencies, and public health agencies
• Comprehensive outpatient rehabilitation facilities
• Hospices
• Critical access hospitals
• Community mental health centers
• Religious nonmedical healthcare institutions

That said, it is a good risk management practice and a good “quality of care" practice for private physician practices to take “patient complaints" seriously, look into the facts and circumstances involved in the complaint in a timely manner, and respond appropriately to the patient's concern. Any written response to a patient complaint should be carefully considered and written with the knowledge that the physician/physician practice's written response could be used in litigation.

A practice may wish to develop a policy or guidance for the office manager or whomever the practice designates for managing and responding to patient complaints. For more information, refer to the webinar Patient Feedback: What Do We Do with It? and the guidance article Managing Risks in Physician Practices.

The recommendations contained in Ask ECRI do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.