Medical Staff

Should we credential an external peer reviewer?

Medical Staff Leader Connection, April 26, 2007

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Dear medical staff leader,

A colleague recently asked me if her facility should credential a person brought in to conduct an external peer review. This MSP had conflicting advice from other colleagues in the field. Some said the external peer reviewer need not be credentialed by the hospital if he or she is affiliated with an agency and is an expert witness. Other MSPs told her to appoint the external peer reviewer to the staff without privileges. Still others asserted the hospital did not have to credential the outside reviewer.
 
The MSP felt the hospital should at least verify the peer reviewer's credentials to ensure he or she was competent to conduct the review. Trusting this task to an outside agency didn't seem right to her. How could she convince the medical staff the file was reviewed by an expert witness if the hospital didn't know the outside reviewer's background?

The answer to this question depends on her hospital's policies. If the hospital's policy requires it to grant temporary appointment to an outside peer reviewer, the organization must credential the outside expert in accordance with its membership requirements. However, if the medical staff bylaws and hospital policy don't require credentialing of external peer reviewers, I contend that this isn't a credentialing issue. To me, this is much like hiring a consultant. The hospital must always ensure consultants are truly experts.

If the outside reviewer is affiliated with an agency, the agency should provide the hospital with verified information about the outside reviewer's expertise. It is not necessary for the hospital to re-verify that information. For example, The Greeley Company's external peer review practice conducts criminal background checks on all reviewers and confirms board certification. The prospective reviewer is also interviewed by a senior member of The Greeley Company.

Hospitals working with a practitioner from The Greeley Company's external peer review practice receive a copy of the reviewer's circulum vitae. In addition, The Greeley Company obtains the name of the physician under review to assure that the external reviewer does not have a prior association or knowledge of this individual.

Although external peer reviewers affiliated with The Greeley Company have never been granted a staff appointment as part of their external peer review work, some hospitals do ask The Greeley Company to sign the organization's business associate agreement. 

On the other hand, if the practitioner performing external peer review is not affiliated with an agency, the hospital should verify his or her expertise. It is fast and easy to obtain an AMA profile for information on the reviewer's education and training.  A reference attesting to the consultant's area of expertise is also important.

That's it for this week. Let me know if you have questions that can be answered through this column. I can't respond to all questions individually, but will be happy to consider responding via this column if your query is of general interest to our readers.

Until next time,

Vicki L. Searcy, CPMSM
Practice Director, Credentialing & Privileging
The Greeley Company
vsearcy@greeley.com
www.greeley.com



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