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Using external peer review

Credentialing Resource Center Connection, January 2, 2008

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Anne Roberts, CPMSM, CPCS, is the director of medical affairs at Children's Medical Center in Dallas, where she oversees the medical administration, graduate medical education, and medical staff services departments.

Dear credentialing colleague:

MSPs often wonder when it is appropriate for a hospital to refer a case for external peer review. It is best practice for hospitals to have a policy that clearly describes the circumstances under which it would seek the assistance of an external peer review organization. Prior to utilizing an external peer review organization, the hospital should do its due diligence to research the external organization's reputation, as well as review the competency, training, and experience of the reviewer.

Some examples of circumstances for which hospitals should use external peer reviews include (but are not limited to) the following examples:

• Lack of internal expertise: Many hospitals, particularly rural facilities, are occasionally forced to rely on external peer review organizations because current medical staff members do not have expertise in the specialty under review.
• Conflict of interest: Organizations should also use external peer review organizations when the only practitioners on the medical staff with expertise to review the specialty are associates, partners, or direct competitors of the practitioner under review. Organizations need to ensure that they do not give any room for an accusation of bias.
• New technology: When an organization purchases new equipment or researches new techniques, it may not have current medical staff members with the appropriate training or experience. Organizations can utilize external resources to provide the training or proctoring necessary to implement the new techniques.
• Miscellaneous issues: Most hospitals adopt external peer review policies that allow the medical executive committee and governing board to use external peer review whenever they deem it appropriate (e.g., when the medical staff needs an expert witness for a fair hearing, to evaluate a practitioner's credentials file, or to develop benchmarks for quality monitoring.)

Failure to recognize when to use external peer review can be a legal liability not only for those participating in peer review, but also for the organization. Having a clear policy in place will help the organization make the right decision when an issue arises.
   
Remember, clear, effective communication is the key to success!

That's all for this week.

All the best,

Anne Roberts, CPMSM, CPCS

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