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Avoid conflicts and eliminate bias by engaging an outside peer review firm

Credentialing and Peer Review Legal Insider, August 1, 2010

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Credentialing and Peer Review Legal Insider.

It is important for your medical staff to determine why it is considering external peer review before engaging a firm. Does your medical staff lack expertise, or is it riddled with conflicts of interest? “The first thing is to determine why you are doing it because that will determine the number of cases you need to look at,” says Robert J. Marder, MD, CMSL, vice president of The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.

According to External Peer Review: When and How, a white paper published by The Greeley Company in May 2009, the most common reasons medical staffs engage an external peer review firm are:

• Lack of appropriate internal expertise 
• Ambiguous or conflicting recommendations from internal reviewers or medical staff committees 
• Lack of credibility
• Legal concerns regarding cases that result in litigation 
• A desire to benchmark performance 

Once you’ve established why your medical staff is seeking an external reviewer, you can determine the type and number of cases you need to send out for review. For example, does your medical staff want an external reviewer to examine all cases in which a problem has been identified, or do you want to send a random sampling of cases to help identify trends? For the former, your medical staff will only need to send out cases that have been red-flagged. For the latter, you need to identify a subset of cases, such as a percentage of cases based on volume or all cases that have a certain outcome.

“We have one hospital that refers all of their mortality reviews to us, regardless of whether they suspect something went wrong,” says Judy Ring, RN, BSN, project manager and corporate compliance manager at CIMRO, an external peer review firm in Champaign, IL.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Credentialing and Peer Review Legal Insider.

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