This week's problem is addressed by Jon Moses, MHA. Mr. Moses is President and CEO of MDReview which he co-founded. He is a former hospital CEO with over 25 years senior hospital leadership experience.
Problem:
"We have decided that we need external peer review for a number of cases. We have not used external peer review before and are not certain as to how to evaluate the available options."
Solution:
This was exactly the challenge the founders of MDReview
faced which lead to our creation of MDReview. On several occasions, we identified our need for an objective external
peer assessment. But given the limited
number of satisfactory options available, we came to dread the process. And as we came to terms with how serious the
ramifications of peer review could be, our anxiety grew. Would the
review be completed in support of
our timeline? Would it be well written,
clear and concise? Would the report
provide clear conclusions that were well supported? Would the physician
reviewer be credible? What would happen if we spent a great deal of
time, effort and money for the review and received an inferior report?
Given hourly billing, what would the peer
review cost? Would the physician
reviewer provide us with ongoing support should we have follow up
questions or
need involvement in a fair hearing?
As the number of external peer review providers has grown,
so has the challenge of differentiating one from the next. Given
similarities in terminology and
promotional language, it would appear that the various firms approach
peer
review similarly. However, peer review
firms vary widely in the way they conduct peer review. Some of the
differences are dramatic. For example, some firms involve
non-physicians to write an abstract from the medical record and it is
that
abstract that is reviewed by the physician reviewer. Others are averse
to such abstracting and
insist that no one come between the medical record and the physician
reviewer. Some firms require that you enter into a 30
page agreement while others require no agreement at all. Some charge
$2,500 while others charge $500
to review the very same case. The
differences among firms are stark and compelling.
At the same time, healthcare organizations vary in what
attributes they demand of a peer review firm. Some have given little thought to either the options or the implications
of their selection. There are choices
and the choice your organization makes is critical. It can mean the
difference between a high
integrity, respectable process and one that is indefensible and
diminishes
trust. I suggest close scrutiny of any
prospective external peer review partner. As you seek a partner that supports your organization's culture and
approach to peer review, consider getting answers to the following
questions
from all prospective firms:
- How do you ensure that your physician reviewers are credible? Do they have the appropriate qualifications? Are they actively practicing and board certified? Are they carefully matched to the specifics of each case? Will we have a say in which reviewer is used for each project?
- Do you train your reviewers to conduct peer review? How?
- Do you monitor the work of each reviewer? How do you make sure your reviewers adhere to the highest standards?
- What is your track record with respect to timeliness? Do you meet your deadlines?
- Do you have a consistent report format that never fails to provide clear, concise conclusions?
- Can you assure us that your reviewers will be available for subsequent proceedings after the review? Will they address follow up questions? Are additional fees involved?
- Will we know the cost of each engagement up front or not until the invoice arrives?
- Do you assign a project management team to each project to ensure that the work is done to standards?
- Are the reports proofread before being finalized? By whom?
- What kind of agreement do you require that we execute to be able to access your services?
- What steps do you take to make sure each review is objective, fair and balanced?
- How easy is your firm to use?
- Does your firm have strong references that reflect an outstanding track record?
- What is the level and type of experience of your firm's leadership? How is this experience relevant to physician peer review?
- Given the wide variety in fees, are yours competitive? How are your fees set? What are we getting for our money?
- Is your company as serious as we are about preserving confidentiality?
- What is your process for conducting the review?
All peer review is not conducted in the same fashion. In fact, there is tremendous variability. The approach used can directly affect the integrity of your process, favorably or adversely. The implications are simply too important to allow the selection of an external peer review partner to be taken lightly.
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