Mediation as a Way to Resolve Complaints The proven benefits of mediation are being applied to the nation’s Medicare program, the health insurer for 42 million beneficiaries across the country. The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, offers mediation as an option to resolve quality of care complaints that Medicare patients or their representatives file involving a practitioner or health care provider.
Background
For several decades, Medicare beneficiaries have contacted Quality Improvement Organizations (QIOs), federally-funded government contractors located in each state, when dissatisfied with the quality of health care provided by their practitioner or health care provider.
In 1998, CMS sponsored a successful one-year pilot program to test whether mediation helped to resolve Medicare beneficiaries' complaints. The pilot revealed that mediation produced high satisfaction among beneficiaries and improved the relationship between them and their health care providers and practitioners. The pilot also indicated that mediation might reduce allegations of malpractice that end up in court.
Program Summary
Mediation is a consensual and collaborative process in which the parties have agreed to mediate in good faith and to authorize a third party, the professional mediator, to facilitate their efforts to reach a resolution. In contrast to arbitration, the parties themselves decide on the outcome and create a mutually agreed upon resolution.
Mediation is a voluntary process and either party can withdraw at any time, in which event the case would revert to the traditional medical record review process. The mediation process is strictly confidential. No records are kept, and anything stated in the hearing cannot be used in any legal proceedings. If the parties reach an agreement, it will be shared with the QIO to follow up to make sure that the terms of the agreement are implemented.