The Network’s case review responsibilities include investigating and resolving grievances filed with the Network and addressing non-grievance access to care cases. CMS views the investigation and resolution of grievances and non-grievance access to care cases as an opportunity to focus on meeting the needs of ESRD patients as well as an opportunity to create change by listening to and learning from the patient’s and/or caregiver’s perspective.  Change occurs when dialysis facilities understand the root cause(s) of the grievance issue and implement steps to resolve the issue(s). The steps that lead to resolution may be simple and specific to the grievant or there may be a need for a systemic change to correct the issue for the benefit of all patients within a dialysis facility.

Grievances: The Role of the Network

Depending on the details of a case, the Network may assume one or more of the following roles in addressing a grievance filed by an ESRD patient, an individual representing an ESRD patient, or another party:

  • Facilitator
  • Expert investigator
  • Educator
  • Advocate
  • Referral source
  • Quality improvement specialist

Upon the receipt of a grievance, the Network will classify the case as one of the following:

  1. Immediate Advocacy - concerns that are non-clinical in nature and do not require a complex investigation; resolved in 10 calendar days or less
  2. General Grievance - concerns that are non-clinical in nature but require complex investigation and review of records; resolved in 60 calendar days or less
  3. Clinical Quality of Care - concerns that involve clinical or patient safety issues and requires a clinical review of records by an RN and/or the Medical Review Board (MRB); resolved in 60 calendar days or less

Please note that you will be contacted via phone and/or in writing once a grievance has been filed with the Network. You will be required to provide records as requested within the time frame outlined by the Network. Recommendations for quality improvement efforts will be made once all issues have been investigated. The Network will guide you through all quality improvement efforts and will continue to provide support and follow-up as necessary. We share your goals to ensure that all care provided to patients in our service area is of the highest quality possible.

Tools & Resources

As required by the conditions for coverage, please ensure that all patients are educated on the grievance process and the various options when filing a grievance by providing ongoing individualized education as well as displaying the Network "Speak Up!" poster in a common area that patients and visitors have access to (such as the unit lobby).

Grievance Posters

Pt Exp of Care
If you have questions or need assistance, please contact us:
ESRD Network of New England (Network 1)
ESRD Network of New York (Network 2)
ESRD Network of the South Atlantic (Network 6)
ESRD Network of the Ohio River Valley (Network 9)

Resources for Patients

Resources for Healthcare Professionals