Attendance seems high and there is plenty of energy in the hallways and presentation rooms. The most compelling presentation of the morning to my ears was titled "ADR in Health Law: A Primer on the Parties; Issues; Relationships; and ADR Perspectives."
Perhaps the titled doesn’t do it justice, but the panelists were an experienced healthcare mediator, an attorney for a large California health plan, and an attorney for several large California medical provider groups. The two advocate panelists have faced each other many, many times in negotiations, mediations, arbitrations and in court.
The most remarkable aspects of these disputes from my perspective are:
- The complex network of relationships involved
- The complex legal issues involved (particularly where there is no payor-provider contract upon which to base payment determinations)
- The big picture outlook that these parties have to keep in mind because they need to continue to business with one another going forward
- The public policy considerations that come into play, even where the dispute is between an insurer and physician group over the amount of money that is owed for services rendered.
And, the whole healthcare payment system is constantly in flux. In fact, active healthcare payments mediators are often ignorant of the most recent developments because the cases they mediate involve contracts that were executed a few years earlier, when these transactions where structured in a different way.
Finally, the California Department of Managed Health Care has recently rescinded proposed regulations that would have created an arbitration program to resolve payment disputes between payors and noncontracted providers. It will be interesting to see if new proposed regulations emerge to take their place.
-Mark Fellows
See also:
State drafts rules to regulate emergency room payments (LA Times, 4/1/08)
Arbitration resolves billing disputes without costly litigation (Managed Healthcare Executive, 2/1/07)
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