Sometimes Medicare patients and their families/representatives need to make quick decisions or find themselves in circumstances that require pressing action. To assist, the two Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) offer a voluntary service for people with Medicare called the Immediate Advocacy process.
Immediate Advocacy is an informal dispute resolution process used to quickly resolve a verbal complaint a Medicare beneficiary has regarding the quality of Medicare-covered health care. It is a voluntary process for both the Medicare beneficiary and the provider. Through this process, BFCC-QIO staff makes immediate, direct contact with a provider and/or practitioner on behalf of beneficiaries and their families or representatives to obtain the information they need to make important decisions. Below are two examples of Immediate Advocacy success stories.
One example of the importance of Immediate Advocacy involves a patient receiving home health care in New Hampshire. The patient’s wife heard the home health aide explain how she should fill her husband’s pill box with medications and monitor his blood pressure. Concerned about taking on these tasks herself and believing that the home health aide should provide this medical care, the wife contacted1-800-MEDICARE to express her concern. The call center transferred the wife’s call to Livanta—the BFCC-QIO for New Hampshire and 19 other U.S. states and territories—for Immediate Advocacy.
The BFCC-QIO contacted the director of the home health agency to discuss the wife’s concerns, which identified the root of the miscommunication. The director explained that the aides intended to educate family members about what the aides would be overseeing: medications in the pill box, the dates and times to take the medications, and how blood pressure is taken and monitored. The aides never meant to teach family members how to administer the care themselves. Understanding the potential for misunderstanding, the director promised to educate her staff about clearly communicating the agency’s role to patients and family members. When the BFCC-QIO called the patient’s wife to explain them is understanding and the home health agency’s plan of care, she expressed relief and thanks.
“We know that individuals acting as caregivers frequently feel anxious about their care giving responsibilities,” says Jennifer Bitterman, director of communications for Livanta. “Anytime we can help alleviate some of that stress as quickly as we do through Immediate Advocacy is a huge benefit to caregivers.”
Another Immediate Advocacy example comes from KEPRO – a BFCC-QIO representing more than 30 U.S. states. KEPRO answered a call from a Medicare beneficiary’s son who needed help determining whether he could appeal his mother’s hospital discharge. An appeal can be filed if the Medicare patient has inpatient status at the hospital; an appeal cannot be filed if the patient is considered an outpatient in observation. The status of this patient was not clear to the family since she had been moved back and forth between observation and inpatient status several times. KEPRO reached out to the provider and learned she was considered an inpatient and assisted the son with the appeal process.
The son expressed appreciation for the clarification that he was not able to obtain on his own. The hospital discharge planners also expressed gratitude to the BFCC-QIO for alerting them to the communication issue of which they had been unaware.
“In the past, BFCC-QIOs addressed only quality of care complaints, which are very structured and regulated. Quality of care cases only reviewed what could be found in a medical record, to evaluate right from wrong,” says Rita Bowling, Area 3 program director for KEPRO. “But we found that a lot of things being complained about would never be written in a medical record. Most difficulties people have with health care are not related to standards of care being met but to their experience of care. Person and Family Engagement activities like Immediate Advocacy open up whole new avenues for us to be able to assist beneficiaries.”
After the Immediate Advocacy process concluded, KEPRO invited the patient and his son to be part of the Beneficiary Health Care Navigation Program offered by both BFCC-QIOs to help guide the family through the care transition from hospital to rehabilitation facility and beyond. “We listen, give support, and teach beneficiaries and their families how to become self-advocates and to better prepare them to navigate the health care system,” Bowling says.