When working with disputes in the healthcare industry, there are multiple dynamics to be considered. Because there are different factors that can influence these cases, a mediator should be prepared to handle and resolve many different types of disputes that might emerge in this particular field. While they are indeed varied and wide-ranging, the most typical disputes in healthcare are payor (insurer) provider (hospital or doctor) disputes, risk management controversies, reimbursement payment disputes involving private or governmental payors, patient safety claims against hospitals and other care facilities, disputes among members of a physician group or between physician groups, ACO disputes (distribution of bundled payments, governance, quality determinations, etc.), allegations under the False Claims Act, fraud issues and conflicts related to mergers and acquisitions.
Primarily because of concerns about patient privacy and confidentiality, extra energy and attention goes into resolving disputes healthcare industry. Other major reasons for this additional effort include bringing about a timely conclusion to disputes that may involve the life or death of a patient, personally identifiable confidential healthcare information, continued management of important relationships with other healthcare participants, satisfaction of patient safety concerns, and an avoidance of public controversy issues that might hurt the reputation or political positioning of healthcare organizations. Despite these concerns and motivation, a confidential, effective, efficient and expert resolution of a healthcare dispute is not impossible if the case is handled by a trained mediator.
Mediation and arbitration bring specific benefits to these kinds of cases in more ways than one. First off, mediation and arbitration appeal to individuals and businesses involved in healthcare disputes because they are more private than court proceedings. Going through alternative dispute resolution (ADR) ensures confidentiality and that case facts and settlement agreements do not become public record, an aspect that is valued by people and companies that could potentially be damaged by a public relations fiasco.
Various forms of ADR also tend to generate conclusions much more quickly in most cases. This expedited process allows the involved parties, whether the dispute is between providers or payors and providers, to be free from excessive emotional trauma as well as to get on with their lives. Because time and stress is often an important factor in recovery, it is critical that the resolution process be quick and confidential. Another aspect to consider is the nature of the relationship between parties. When dealing with complex issues and interrelated parties, a court-mandated solution might not be the best for, or even applicable to, all concerned. Mediation and arbitration gives the involved parties the ability to create tailored and flexible solutions that are amenable to them.