A new CMS mediation program for face-to-face meetings between patients and physicians will provide an alternative to the medical record review process for dealing with complaints about medical quality.
With the new option, available this fall, a Medicare quality improvement organization (QIO) decides if a complaint is suitable for mediation. However it will not be available for serious quality-of-care concerns.
Medicare QIOs receive about 2,500 quality complaints annually from beneficiaries. Resolution of complaints can take from 85 to 165 days under the current medical record review process. If both parties agree to meet in mediation, a typical session takes between two and four hours, says Sandy Hall, a spokesperson for the Illinois Foundation for Quality Health Care, the Illinois Medicare QIO based in Oak Brook, Ill.
"When an agreement is reached, the patient's dissatisfaction is relieved and the physician or provider is saved from more time-consuming processes, such as the traditional medical record review process, licensing investigation or litigation," Hall says in a written statement.
The new program "allows both parties a chance to tell their side of the story and resolve their disputes in a neutral and confidential environment," Hall says.
A six-state pilot project in 1998 and 1999 laid the groundwork for the national mediation program.
Participation in mediation is free and voluntary, and either party can withdraw from the process at any time. Sessions are facilitated by a professional mediator and are confidential. The law prohibits use of anything said during mediation from being used in court.