Mediation Overview A Medicare beneficiary went to see an orthopedist about neck pain. She later filed a quality of care complaint, saying he did nothing to help her. The medical record shows the physician discussed a variety of treatments, but the patient failed to choose one or to return for a follow up visit.

In the past, Medicare beneficiaries had only one way to resolve quality of care complaints. Now they have another: mediation.

The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, is offering mediation to resolve quality of care complaints that Medicare patients or their representatives file about a practitioner or health care provider.

Malpractice vs. Miscommunication Malpractice attorneys say miscommunication is the root of 80 percent of malpractice cases. When miscommunication leads to a complaint, mediation is the least confrontational and most personal way for physicians to address it.

Not all beneficiary complaints are suitable for mediation. Quality Insights will review the complaints, and if no serious quality of care issue exists, the review case manager will offer mediation as an alternative to traditional medical record review.

Mediation has long been used to reach a compromise in divorces, labor relations, and environmental disputes, but its use in health care is relatively new. Before implementing this method of conflict resolution, Medicare tested it for a year in six states and found most participants were satisfied with the results. What’s more, the pilot project suggested mediation might reduce allegations of malpractice brought to trial in court.

Key Features Mediation’s key features are:

  • An impartial professional mediator
  • Voluntary participation at no cost to either party
  • Strict confidentiality that prohibits record keeping and protects the proceedings from being used in court
  • A chance to have your say and to respond to the other party
  • The option to withdraw anytime
  • The health care provider and the beneficiary meet face-to-face or talk over the phone if distance or disability is a factor, and the mediator helps the parties reach an agreement that results in a signed contract.
  • Some physicians may think mediation takes too much time because it usually takes two to four hours. But in the long run, it can save physicians and providers from even more time-consuming licensing investigations and litigation.