Alternative dispute resolution, or ADR, is the practice of resolving disputes through processes other than litigation. The most common forms of ADR are mediation and arbitration, but many other forms exist in the Health Care arena to address specific types of disputes and their need for tailored processes for unique situations. Some of these include hearing officers for hospital hearings, referees for discovery disputes and early neutral evaluation of cases.
Lawyers specializing in the Health Care field are required to utilize many skills, techniques and methods to resolve disputes for their clients. Health Care lawyers must remain up-to-date on regulatory changes, industry trends, the economic climate and changes in the law.
Viggo Boserup, Esq., CEDS, is a JAMS neutral attorney based in Los Angeles
California. In addition to more than 20 years as a full-time mediator
and arbitrator, Mr. Boserup serves as special master and referee in a
number of cases involving electronic discovery. He is certified as an
Electronic Discovery Specialist by the Association of Certified Electronic
Discovery Specialists (ACEDS). He can be reached at
vboserup@jamsadr.com.
Brian Parmelee based in Los Angeles, CA is Vice President of Corporate Development and
Panel Relations at JAMS. He focuses on strategic initiatives, market
expansion, and corporate business development opportunities.
Parmelee works closely with the CEO as well as JAMS management
and marketing teams to maximize the practices of the panel and
ensure that JAMS continues to offer premier dispute resolution services.
He can be reached at bparmelee@jamsadr.com.
Jerry P. Roscoe, Esq., based in Washington, DC serves exclusively as a mediator and arbitrator.
He brings over 20 years of experience in the resolution of complex,
multiparty matters, including Supreme Court cases and
international conflicts. He can be reached at jroscoe@jamsadr.com.
Hon. Janice M. Symchych (former) from Minneapolis, MN is a veteran ADR professional
and federal courts practitioner with over three decades of legal and
judicial experience. A former magistrate judge for four years, Ms.
Symchych also served as Deputy General Counsel of Litigation at
Medtronic, Inc. She can be reached at jsymchych@jamsadr.com.
R. Wayne Thorpe, Esq., from Atlanta, GA has been a full-time ADR neutral attorney with
JAMS since 1998. He has served as mediator, arbitrator, facilitator,
special master, and case evaluator in roughly 2,000 cases in more
than 15 states, including many high-stakes and complex cases, class
actions, MDLs, and other large-scale multi-party cases, and more
than 500 arbitrations as sole arbitrator, panel chair, or party-appointed
Contents
Chapter 1
What Is ADR in Health Care? . . . . . . . . . . . . . . . . . . . . . . . . . 1
A. What Is Mediation in Health Care? . . . . . . . . . . . . . . . . 2
B. What Is Arbitration in Health Care? . . . . . . . . . . . . . . . . 4
C. What Is Judicial Review? . . . . . . . . . . . . . . . . . . . . . . . . 6
1 . Arbitration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2 . Mediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
D. What Is a Special Master? . . . . . . . . . . . . . . . . . . . . . . . . 8
Chapter 2
Why Use ADR in Health Care? . . . . . . . . . . . . . . . . . . . . . . . 1 3
A. Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5
B. Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5
C. Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6
D. Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6
E. Finality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7
Chapter 3
ADR for Physician/Hospital Employment-Related Issues . . 1 9
A. Physician Employment-Related Issues . . . . . . . . . . . . 1 9
B. Disputes in the Physician Employment Setting . . . . . 2 0
1 . The "Simple" Contract Case . . . . . . . . . . . . . . . . . 2 0
2 . Restrictions on Future Practice: Non-competes,
Non-solicits, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1
3 . Physician Recruitment Deals . . . . . . . . . . . . . . . . . 2 2
4 . Employment Discrimination . . . . . . . . . . . . . . . . . 2 2
5 . Practice Break-Up Cases . . . . . . . . . . . . . . . . . . . . 2 3
6 . Merger and Acquisitions (M&A) . . . . . . . . . . . . . . 2 3
C. Dispute Needs and Concerns in Health Care . . . . . . . 2 3
D. Use of ADR in Physician Employment Disputes . . . . 2 4
1 . Arbitration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5
2 . Mediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 7
iii
iv What Is… ADR in Health Care Disputes?
Chapter 4
ADR in Health Care Business Contracts Disputes . . . . . . . 2 9
A. Licenses and Other Technology-Based
Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 9
B. Management Contracts . . . . . . . . . . . . . . . . . . . . . . . . . 3 0
C. Medical Records Contracts . . . . . . . . . . . . . . . . . . . . . . 3 0
D. Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1
E. Resolving Health Care Business Disputes . . . . . . . . . . 3 1
1 . Reduction of Time and Cost . . . . . . . . . . . . . . . . . . 3 3
2 . Finality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4
3 . Preservation of Relationships . . . . . . . . . . . . . . . . . 3 4
4 . Protection of Privacy and Confidentiality . . . . . . . 3 5
5 . Timely Elimination of Existential Disputes . . . . . . 3 5
Chapter 5
Payor-Provider Disputes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
A. A Different Kind of Mediation . . . . . . . . . . . . . . . . . . . 3 7
B. Unique Qualities of Payor-Provider Disputes . . . . . . . 3 8
C. Advance Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
D. How to Manage the Mediation Effectively . . . . . . . . . 3 9
E. Organizing the Mediation Process . . . . . . . . . . . . . . . . 4 0
F. Cost Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0
Chapter 6
Fraud and Abuse, False Claims Act, and Quality of Care . . 4 3
Chapter 7
Resolving Allegations of Medical Negligence . . . . . . . . . . . . 4 9
A. What Happened and Why: How Mediation Continues
the Healing Process in Medical Malpractice Cases . . 5 1
Chapter 8
Regulatory and Pricing Issues . . . . . . . . . . . . . . . . . . . . . . . . | 5 5 |
A. Regulatory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 5 5 |
B. Pricing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 5 6 |
Contents v
Chapter 9
Dispute Resolution in Health Care Consolidations . . . . . . . | 5 9 |
A. Contractual Disputes . . . . . . . . . . . . . . . . . . . . . . . . . . . | 6 1 |
B. Noncontractual Disputes . . . . . . . . . . . . . . . . . . . . . . . . | 6 3 |
1 . New Co-workers . . . . . . . . . . . . . . . . . . . . . . . . . . . | 6 3 |
2 . Change from Quantity to Quality . . . . . . . . . . . . . | 6 3 |
3 . Cultural Mix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 6 4 |
Chapter 10
Benefits of Using Dispute Resolution in Pharmaceutical/ Products Liability Cases . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5
Chapter 11
Using Dispute Resolution Tools to Manage Other
Health Care Disputes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 9
A. Long-Term Care Disputes . . . . . . . . . . . . . . . . . . . . . . . 6 9
B. Elder Disputes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1
Chapter 12
Management of Conflict in Health Care Businesses . . . . . . 7 3
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 9
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