NASHVILLE, TN - The healthcare system can be difficult for people with Medicare to deal with in normal times. Now, as the Coronavirus (COVID-19) crisis is affecting all areas of health care, Kepro’s Immediate Advocacy process can be especially helpful. Through this process, Kepro serves as an advocate for those people who have Medicare to access needed health care.
Kepro is a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) contracted with the Centers for Medicare & Medicaid Services (CMS) to provide several services, including Immediate Advocacy, to Medicare recipients. It is a process that quickly resolves verbal complaints that a person may have about the quality of health care she or he has received.
Immediate Advocacy involves Kepro contacting the Medicare beneficiary’s practitioner and/or provider, usually by telephone. The process is totally voluntary for both the beneficiary and provider (e.g., hospital, skilled nursing facilities) or practitioner (e.g., doctor).
Immediate Advocacy can be useful during times of crisis, such as during the aftermath of a hurricane. During the current situation with COVID-19, people with Medicare and their families have been calling Kepro with concerns about prescription refills, discharge questions, and concerns about communications with facilities (e.g., hospitals, skilled nursing facilities).
Here is one example of how the Immediate Advocacy process worked:
A Medicare patient’s husband called Kepro with concerns about his wife who was in the hospital. Because he spoke Spanish, an interpreter was involved. He told Kepro that before his wife was in the hospital, they had a friend over who tested positive for COVID-19. His wife then became ill. She had a fever, diarrhea, and didn’t feel like eating. She was taken to the emergency room, where she was tested, intubated, and admitted to the intensive care unit (ICU).
The patient’s husband was very upset over what was happening to his wife. He was having a hard time getting information from the hospital staff about her. He called Kepro to ask if we could help him to get regular updates on her condition.
A Kepro social worker talked with the chief nursing officer (CNO) from the hospital about the patient and explained how the husband was not able to get any updates about his wife’s condition from the hospital staff. The CNO said that the staff attempted to contact the family once or twice each shift. However, the hospital staff was spending most of its time taking care of patients during this crisis. She stated that she would take the husband’s concerns to the director of nursing and would have someone contact him regarding a resolution.
The husband did get a call from the hospital saying that they had put a plan in place to make sure that he would get a daily update about his wife’s condition.
"Thank you for your help, Kepro. You were able to get the information that I was unable to get on my own," said the patient's husband. "I feel so much better knowing what’s happening with my wife."
Kepro urges people with Medicare who are not happy with the care they received or who need help working through an issue that needs resolved right away, to call and ask about Immediate Advocacy. Visit www.keproqio.com/IA for more information about Immediate Advocacy and for Kepro’s Helpline telephone number.
Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization.