Objectives: To assess whether Medicare patients' reports of denied care, appeals/complaints, and satisfactory resolution were associated with ratings of their health plan or care.
Study Design: Retrospective analysis of 2010 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data.
Methods: Multivariate linear regression of data from 154,766 respondents (61.1% response rate) tested the association of beneficiary ratings of plan and care with beneficiary reports of denied care, appeals, complaints, and complaint resolution, adjusting for beneficiary demographics.
Results: Beneficiaries who reported being denied needed care rated their plans and care significantly less positively, by 17.2 points (on a 100-point scale) and 9.1 points, respectively. Filing an appeal was not statistically significantly associated with further lower ratings. Beneficiaries who filed a complaint that was satisfactorily resolved gave slightly lower ratings of plans (-3.4 points) and care (-2.5 points) than those not filing a complaint (P <.001 for all results).
Conclusions: Lower ratings from patients reporting complaints and denied care may notably affect the overall 0-10 CAHPS ratings of Medicare Advantage plans. Our results suggest that beneficiaries may attribute the actions that lead to complaints or denials to plans more than to the care they received. Successful complaint resolution and utilization management review might eliminate most deficits associated with complaints and denied care, consistent with the service recovery paradox. High rates of complaints and denied care might identify areas that need improved utilization management review, customer service, and quality improvement. Among those reporting being denied care, filing an appeal was not associated with lower patient ratings of plan or care.
Download full-text PDF |
Source |
|---|
Publication Analysis
Top Keywords
Similar Publications
User Insights into Fake Snap-on Veneers: Perceptions and Experiences.
Clin Cosmet Investig Dent
October 2024
Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
Purpose: The aim of this pilot study was to assess the knowledge and perceptions surrounding the use of fake snap-on veneers, as well as to evaluate the experiences of individuals who have used them.
Materials And Methods: This study was conducted between October 2021 and January 2022. A questionnaire was distributed through social media platforms to individuals aged >18 years in Saudi Arabia, which assessed their personal and sociodemographic information and perceptions and experiences with fake snap-on veneers.
Background: Disciplinary law is regulated differently in Belgium than in the Netherlands. The Belgian Order of Physicians is responsible for the disciplinary supervision of physicians. The order is an institution with legal personality and has a three-tiered structure, two of which have judicial authority, namely the ten provincial councils and the two appeal councils.
View Article and Find Full Text PDFLessons Learned from Dutch Medical Disciplinary Law Regarding Aortic Aneurysm and Dissection Care.
Ann Vasc Surg
December 2024
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address:
Background: The current study is an explanatory analysis of Dutch disciplinary law regarding aortic aneurysm and aortic dissection care. We aim to give insight in the way disciplinary judges rule on quality of care and to extract the lessons to be learned.
Methods: The online open-access governmental database, which includes all disciplinary rulings since 2010, was searched using search terms related to aortic aneurysm and dissection care.
Access to Justice: The Quest for a Right of Appeal in New Zealand's Health and Disability Commissioner Complaints Scheme.
J Law Med
December 2023
Professor, Auckland Law School, The University of Auckland, Auckland, New Zealand.
Given the absence of a civil damages action for personal injury in New Zealand, its Health and Disability Commissioner's (HDC) complaints process occupies a pivotal role in its medico-legal arrangements. Much hope was invested in it, but as currently configured, the regime is incapable of delivering justice or fulfilling its legislative purpose in a good number of cases. Many hundreds of complaints per annum, in which there is a strongly arguable case of deficient conduct or more than a mild departure from acceptable standards and in which a serious outcome has resulted, are not fully investigated; and there is no mechanism to appeal an adverse HDC decision that a party considers substantively unfair.
View Article and Find Full Text PDFInsights from UKCTOCS for design, conduct and analyses of large randomised controlled trials.
Health Technol Assess
August 2023
Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
Abstract: Randomised controlled trials are challenging to deliver. There is a constant need to review and refine recruitment and implementation strategies if they are to be completed on time and within budget. We present the strategies adopted in the United Kingdom Collaborative Trial of Ovarian Cancer Screening, one of the largest individually randomised controlled trials in the world.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!