The delivery of health care services has undergone dramatic upheaval, even a revolution, in the 21st century. Insurance companies introduced the first and most striking changes: no longer supplying only money to the practitioner but also patients. Along with the practitioners’ obligations to the insurer came tiered payments and copious regulations, including exclusions and caps. The world of Dr. Smith, the local physician, and Dr. Brown, the local dentist, has been consumed by group practices, operating both inside and outside of hospitals, by HMOs and PPOs, not to mention urgent care centers with physicians on staff and pharmacy-like stores dispensing vaccinations and even offering urgent care services.
The evolved and evolving world of health care is impossible to trace in the scope of one short article. If we can count on anything, we can bet that more change is coming—from the federal and state levels, from the role of insurance companies or their replacement(s), from differing treatment modalities, and from advances in scientific discovery. Where does all this leave health care professionals? Perhaps confused, if not angry, and wondering why he or she went to school for so many years and incurred so much debt to emerge into a health care delivery world that is baffling and ever changing.
Dispute Resolution: Sole Practitioners Enter into Group Practices
In this article we examine the resolution of disputes in the narrow world of group practice health care practices. Sole practitioners find it increasingly difficult to afford to practice alone. They are losing their patient base to families who benefit the most from staying within their insurance network, to HMOs, even to urgent care, a more time- and cost-efficient choice than emergency rooms for those who have infrequent visits to the doctor. Plus, the associated costs of practicing alone keeps rising—paying rent, hiring personnel, buying supplies.
As a result of monetary and personal time pressures, sole practitioners are increasingly, by choice or force, joining group practices. They are entering a new culture with different views of time commitments, treatment priorities and choices, compensation scales and incentives for advancement, the role of management, and so on. Here is where mediation offers a vehicle for dealing with clashes of culture and expectation that can occur when practitioners from different practice entities join together.
Areas to Resolve:
Time spent with patients and follow up
Responsibility for record keeping
Incentives for Advancement Coverage on “off” hours
Becoming a Partner Health focus (e.g., disease treatment, cosmetic)
Management, staff, and clinicians
Group Practices Move into Hospital Setting
Not dissimilar from the conflicts facing sole practitioners, who become part of group practices, are the issues facing independent group practices when they move into a hospital setting. All the areas listed above with respect to patient care, expectations, and advancement within the practice can emerge as topics for discussion. And in the problem-solving arena of discussion is where mediation is most productive.