Medicare quality improvement organizations now have the authority from the CMS to handle complaints about medical quality through a mediation process that brings provider and complainant face-to-face. The option will be introduced in conjunction with the standard medical record review process, said Noah Levine, a spokesman for the Illinois Foundation for Quality Health Care, the QIO for Illinois. A QIO may determine a complaint is suitable for mediation, but both parties will have to agree to the process for mediation to proceed, Levine said. Serious quality-of-care concerns will continue to be handled through the usual peer-review process; however, up to 80% of cases are driven by lack of communication or interactions with physicians or other providers. In a session of a few hours, differences can be resolved, an agreement reached and significant time saved for the provider and Medicare beneficiary, Levine said. No records are kept, each side may respond to the other's version of events, and either may withdraw at any time. The process was tested in a six-state pilot project in 1998 and 1999. -- by John Morrissey
CMS will allow mediation for quality complaints
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