Administrative Memos

200308

FROM: Theodore O. Will, Chief Executive Officer
DATE: Aug 14, 2003
SUBJECT: Mediation in the Medicare Beneficiary Complaint Response Program
IPRO CONTACTS:

Elizabeth Hall, R.N., Esq., Assistant Director, Mediation, CQI and Special Projects, 516-326-7767, extension 394

In 1998, the Centers for Medicare & Medicaid Services (CMS) sponsored a successful one-year pilot test of mediation to resolve Medicare beneficiary complaints. The pilot test, conducted by selected Quality Improvement Organizations (QIOs) including IPRO, revealed that mediation could lead to high satisfaction among beneficiaries, healthcare providers and practitioners. The pilot also indicated that mediation might reduce allegations of malpractice brought to court trials.

This fall, QIOs will implement mediation as an alternative to the current peer review process for Medicare quality of care complaints. We have included the following resource materials, prepared by CMS and the Beneficiary Protection Support QIO (BP-QIOSC) to inform you and your organization about what participation in mediation entails, explain the process, and demonstrate how your organization can benefit from participation:

"Dialogue", a mediation fact sheet;
"Mediation in the Medicare Beneficiary Complaint Response Program", a summary of the Medicare Mediation program; and
"Mediation in Healthcare Complaints - Its Potential Effects and Advantages"; a mediation resource packet for physicians and providers.

We encourage your participation as we embark on this innovative initiative. In this regard, we are requesting designation of an individual within your organization who would have the authority to consent to mediation on a case-specific basis. Please complete the enclosed designation form and return it to Elizabeth Hall at IPRO by September 11, 2003.

Should you have any questions in regard to this memorandum, please feel free to contact Andrea Goldstein, Vice President Medicare/Federal Healthcare Assessment, extension 364 or Elizabeth Hall, extension 394.