This current
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 healthcare leadership experience.
Problem:
"When
we determine it is necessary to send cases for external peer review, we often
struggle with the decision of whether to use in state or out of state
physicians."
Solution:
The most common reason for commissioning external peer
review is to manage conflicts of interest and preserve objectivity. The closer in geographic proximity the
external reviewer is to the subject physician, the more likely is the potential
for bias, whether competitive, relational, perceptive or other. Yet the further away the reviewer, the less
aware or sensitive he or she might be to local standards of care. This brings us to the key determining factor:
If the care provided was or should have been affected by local standards of
care that are perhaps inconsistent with national standards, then a reviewer
familiar with those local standards should be considered. In such cases, the use of a more proximate
reviewer has to be considered against the opposing risk of bias. If, however, the relevant standards of care
are not unique to the local setting, the choice becomes far clearer: A reviewer outside the state without any
meaningful knowledge to the subject physician or hospital should be
pursued.
Most typically, standards of care are not unique to the
local setting. Therefore, most often,
selection of a reviewer who is not familiar with the local physicians,
hospital, politics or other factors is the highest integrity approach.
On occasion, we come across hospitals who feel that the
reviewer must have membership on their medical staff prior to conducting the
review. Of course, this usually
necessitates that the reviewer hold a medical license within the state. This is no longer a commonly pursued
strategy. Given that peer review is not
the practice of medicine and that both federal state peer review protections
have significantly evolved, in most cases neither medical staff membership nor
an in state medical license serve any meaningful purpose.
Generally, the lower the potential for bias, the greater
likelihood for high integrity, defensible peer review. There is a time for use of in-state or local
reviewers; however, use of out-of-state physicians is most often the highest
integrity approach.
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