| When done properly, peer review is an
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| | based upon medical evidence and improve
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| important process that helps hospitals
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| | the fairness of the process for both
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| and their doctors ensure consistent, high
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| | physicians and the hospital.
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| quality patient treatment. Hospitals can
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| | An IRO can match doctors with the right
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| identify at-risk physicians; physicians
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| | specialist expertise to effectively
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| can help improve quality of care for
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| | review sensitive cases and reach an
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| patients. Why is this process so
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| | unbiased determination. Reviews are
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| difficult? It's simple - hospital
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| | conducted by board-certified physicians
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| politics, economic advantage and
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| | in active practice, who are usually
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| personalities.
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| | located in a different state than the
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| The current physician peer review system,
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| | physician being reviewed. Hospitals pay
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| created by Congress in 1986 through HCQIA
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| | only for the reviewing physician's time
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| legislation, was intended to promote
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| | at pre-determined hourly rates.
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| higher quality patient healthcare.
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| | Because these specialists are already on
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| Unfortunately, Congress did not foresee
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| | board, reviews can be completed in much
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| that hospital peer review actually puts
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| | less time and at significantly lower
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| physicians into an environment where
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| | costs. Peer reviews are conducted using a
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| political, economic and personality
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| | standard reporting format, and the
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| conflicts can easily render the process
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| | typical turn-around time is less than 21
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| ineffective. Nor did it foresee that
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| | days. Since IROs review thousands of
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| hospitals would sanction doctors for
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| | cases annually, per case review costs are
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| speaking up on behalf of patients
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| | kept to a minimum.
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| regarding quality of care concerns.
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| | An IRO can give peer review the high
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| In the hospital environment, peer review
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| | priority and timely consideration it
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| is considered an ugly task that is just
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| | deserves -- without impacting the
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| one more action item for a busy medical
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| | hospital staff or tarnishing a hospital's
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| staff and is easily pushed to the bottom
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| | reputation.
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| of the priority list. Often it just
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| | Using an IRO for objective peer review
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| doesn't get done. Why?
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| | may be one of the best solutions for
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| Physicians on peer review or quality
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| | helping hospitals get back to the intent
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| management committees too often find
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| | of the law - improving healthcare quality
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| themselves in conflict of interest
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| | for patients. An IRO can also help reduce
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| situations. They compete for the same
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| | costs, avoid expensive litigation,
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| limited geographic pool of patients and
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| | enhance hospital reputation and protect
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| for professional recognition within a
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| | JCAHO certification.
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| very narrow specialty. There may also be
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| | Peer Review Best Practices
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| personality conflicts with the physician
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| | To ensure an evidence-based outcome for
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| under review or pressure by their
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| | peer reviews, hospitals should consider
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| hospitals not to seriously scrutinize a
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| | this nine step process:
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| fellow physician who has stature in the
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| | 1. Develop a culture of accountability
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| medical community. The tight-knit social
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| | within the hospital.
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| and professional relationships found in a
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| | 2. Make sure that the peer review process
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| hospital environment can lead to bias and
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| | is well defined, understood, accepted and
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| reluctance to pass judgment on
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| | adhered to by all.
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| associates. This reluctance tends to lead
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| | 3. Watch for "sentinel events." Bring
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| to unusually long delays in resolving
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| | patterns of recurring or clustered
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| critical quality management issues. By
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| | problems to management's attention in a
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| the time a critical situation is actually
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| | timely way.
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| dealt with, the costs and risks to a
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| | 4. Assure that questions posed during the
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| hospital or group can be catastrophic.
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| | process are precise, and that responses
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| Backlash
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| | are precise as well, including the hard
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| The breakdown in a hospital's quality
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| | questions, with rationale and associated
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| management system can be very damaging.
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| | guidelines.
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| Inadequate peer review can result (and
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| | 5. Make sure that each peer review case
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| has) in negative consequences for
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| | is reviewed by a "like" specialistwho is
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| hospitals and hospital groups, such as:
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| | unbiased and has no potential for
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| - Negative publicity
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| | conflict of interest inrendering an
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| - High profile lawsuits
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| | opinion.
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| - Multi-million dollar fines
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| | 6. Make sure the peer review committee
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| - Management shake-ups
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| | meets monthly and that cases and replies
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| - Loss of investor confidence
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| | are distributed, reviewed and responded
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| - Damage to physicians' careers and
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| | to in a timely manner.
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| practices
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| | 7. Make sure there is a re-review of each
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| - Joint Commission on Accreditation of
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| | case after the subject physician input
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| Healthcare Organizations (JCAHO)sanctions
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| | has been received.
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| and loss of accreditation
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| | 8. As much as possible, conduct all
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| - Scrutiny by state and federal agencies
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| | reviews in a non-accusatory
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| and other public organizations.
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| | andprofessional format.
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| These negative events, combined with
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| | 9. Systematically send your most
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| rising consumer frustration with the
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| | sensitive peer review cases out to an
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| healthcare system, make it increasingly
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| | Independent Review Organization.
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| imperative that hospitals pay close
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| | Choosing the Right IRO
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| attention to their quality management and
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| | Choosing the right IRO as a partner for
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| adopt best practices whenever possible.
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| | hospital peer review can be as confusing
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| Peer Review as a Risk Management Tool
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| | as the process itself. Here are some
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| A well-executed peer review process can
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| | simple questions to ask in the selection
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| easily avoid such negative events by
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| | process:
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| using best practices in risk management.
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| | 1. Is the IRO URAC-accredited? - There
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| The earlier a physician performance issue
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| | are dozens of companiesthat claim to
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| is detected and dealt with, the lower the
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| | offer medical review services. There are
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| costs and potential negative consequences
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| | only a fewthat are actually accredited by
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| to the hospital and the physician.
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| | the American Accreditation
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| Basing effective peer review on medical
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| | HealthCare Commission, also known as
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| evidence and adhering to the intent of
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| | URAC. By selecting an IROwith URAC
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| the law -- to improve the quality of
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| | accreditation, the hospital partner with
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| patient care -- helps discover, highlight
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| | a standards-based organization can
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| and deal with quality problems quickly
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| | deliver the quality and objectivityneeded
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| and efficiently. Issues surrounding
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| | for the peer review process.
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| internal politics, competition, and
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| | 2. What types of doctors are on staff at
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| personality conflicts should be
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| | the IRO? - It's extremelyimportant to
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| considered when setting up a peer review
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| | work with an IRO that has doctors on
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| committee.
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| | staff trained tomake fast decisions, who
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| Involving Outside Parties in Peer Review
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| | are board certified and still in
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| The most effective quality management
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| | activepractice.
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| process involves using a "neutral"
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| | 3. How deep is the IRO specialty panel? -
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| outside party in addition to the
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| | The IRO under considerationshould be able
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| hospital's own peer review committee.
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| | to deliver the specialists needed on a
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| This neutral party can review sensitive
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| | moment'snotice. Not only do these
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| cases where there is a potential conflict
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| | physicians need to be in the
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| of interest. Hospitals with the need for
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| | samespecialty, but also from the same
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| an outside case review have often turned
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| | type of institution. A heartspecialist
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| to affiliated hospitals or searched for
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| | from Los Angeles may not be the right
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| "like" specialists through personal
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| | physician to reviewa related case coming
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| connections. While this is an effective
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| | from a rural hospital in Iowa.
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| method for solving the problem, it has
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| | 4. What are the standard turn-around
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| its own set of challenges:
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| | times? - The IRO selectedshould have a
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| - How do you quickly locate the right
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| | strong track record of turning around
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| specialist?
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| | reviews quicklyand accurately. Find out
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| - How do you convince them to take time
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| | what the average turn-around times areand
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| to do a peer review?
| |
| | what process the IRO offers for expedited
|
| - How long do you have to wait to get it
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| | reviews. A standardof 21 days or less for
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| done?
| |
| | hospital peer review should be the
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| Unless you have a well-developed process
| |
| | minimum.
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| and pre-arranged agreements with
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| | 5. How accessible are the IRO physicians?
|
| affiliates or physicians to perform peer
| |
| | - Many IROs offer basicpeer review
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| review, it can be very costly and time
| |
| | services. The best IROs, however, are the
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| consuming to arrange for this each time
| |
| | ones thattruly act as partners to the
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| it's needed.
| |
| | hospital peer review committee andmake
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| IROs: A Cost Effective Solution for
| |
| | themselves fully accessible to the
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| Hospital Peer Review
| |
| | physicians under review. Bybecoming a
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| Many hospitals, today, are turning to
| |
| | part of the process, the IRO can truly
|
| Independent Review Organizations (IRO) to
| |
| | act as the neutralthird-party and help
|
| aid in fixing their peer review process.
| |
| | keep the relationships between all
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| An IRO serves as an objective third party
| |
| | parties intact.
|
| that can provide hospital peer reviews
| |
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|
