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Peer Review Monthly: The M&M model is no substitute for peer review

Medical Staff Leader Connection, December 10, 2008

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Dear medical staff leader and professional,

At a recent seminar, an ED physician asked for my opinion regarding a situation that arose in his department’s peer review committee. The committee reviewed two cases with similar care issues approximately three months apart. The committee determined that the physician represented in the first case provided appropriate care and that the physician represented in the second case provided less-than-appropriate care. The physician who was deemed to have provided appropriate care now wants his case reviewed again.

The physician asked me what some of the possible reasons might be for this committee’s inconsistency. I asked if the physicians were present when the cases were presented. Somewhat surprised, he told that indeed they were because they use an M&M (morbidity and mortality) style model for peer review. After I explained that how physicians present their cases and how the group perceives them can affect ratings, it became clear to him that the M& M model is not a good one for peer review. 

Peer review committee meetings are not the same as M&M conferences, even though some hospitals have combined the two. Combining them in this way is a vestige from a time when the M&M conference satisfied regulatory peer review requirements.

I am not opposed to M&M conferences. They are a great educational forum for collegial and open discussions of clinical cases, and hospitals can certainly use them to improve care. Like peer review, M&M conferences focus on individual cases. However, if there is a need for a formal decision, which will go into a physician’s file, the M&M process is flawed. The presence of the individual under review at an M&M conference may cause those reviewing a case to be biased, and the inconsistency of M&M participants over time may skew decisions

There are circumstances in which hospitals can more readily connect the peer review process to the M&M conference, particularly within the context of residency programs. In academic medical centers, for example, residents can identify cases presented in an M&M conference that should be referred to the official peer review process.

If you are still using the M&M model for peer review, it may be time to examine whether it is fair to the physicians under review and to the patients peer review is designed to protect.

Best regards,

Robert Marder, MD, CMSL
Vice President
The Greeley Company

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