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Knowledge Expansion

Ask an Advisor: How soon should my medical practice respond to patient complaints?

Insight Article

Patient Engagement

MGMA Staff Members
No business is immune from customer complaints, and medical practices are no different.

As online review sites and patient satisfaction surveys continue to have sizable influence on the reputation of providers and their medical practices, the timeliness of responding to patient complaints can be as important in resolving the complaint as the way in which you respond.

One MGMA member recently submitted this question to Ask an Advisor:

What is the MGMA recommendation for how quickly patient complaints should be responded to? We try for 24 hours but that is not always feasible.

Cristy Good, MPH, MBA, CPC, CMPE, senior industry advisor, MGMA, managed practices for many years, and in most settings said that a response to a patient complaint should be sent within 24 to 72 hours, and cautioned that not all complaints can be swiftly handled.

“Depending on the complaint or grievance, you may need more time to research and gather information and put together an appropriate response,” Good said. “If we were not able to resolve the problem within the 24- to 72-hour range, we would at least email or call the patient and let them know that we were working on it” and, when possible, include an expectation of how long it would be until another communication would be sent.

In some cases, it is appropriate to empower your front desk staff or nonphysician clinical staff to solve complaints immediately, Good noted. “For example, if a physician was pulled away from the office for an emergency surgery and we were not able to cancel the appointment prior to patient arrival, we might offer them a coffee card or offer to pay for their lunch while they wait if they are not able to reschedule,” Good said.

In those instances, it is important to have a policy on who can make such offers, and some staff may benefit from having a sample script for how to handle a patient complaint.

“The key is to have good communication and a clear process,” Good noted.

Regulations, compliance and risk mitigation

Not every care setting is affected, but the Centers for Medicare & Medicaid (CMS) does require ambulatory surgical centers, facilities for patients with end-stage renal disease and home health agencies to establish patient grievance programs as conditions of participation (CoP) in the Medicare and Medicaid programs, similar to those in place for hospitals. More details on this are available from the ECRI Institute.

As Good wrote in her article for MGMA Connection magazine (“’Sorry’ still matters”), patient relationships play an important role in your risk, especially when an event occurs in which the patient might consider pursuing malpractice litigation:

To help improve communication, COPIC Insurance Company in Colorado began a program called the three Rs: recognize, respond and resolve. The idea is to openly and honestly communicate with patients and encourage their doctors to report unexpected outcomes immediately before any claim is filed.

Sometimes a patient complaint may not have merit yet the complaints persist, causing the physician-patient relationship to be damaged in the process. If this type of situation results in a decision by the medical provider to terminate the physician-patient relationship, you can find a sample patient termination letter along with key compliance issues about crafting a termination policy and avoiding accusations of patient abandonment in a recent MGMA Connection magazine feature.

Additional resources

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