Peer Review: An Important Tool for Hospital Risk Managers

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Leading IRO, AllMed, helps risk management professionals learn how their involvement in peer review can reduce litigation and claims costs, while improving quality of care and physician performance

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Effective peer review has been proven to reduce negative financial consequences for hospitals and providers - Andrew G. Rowe, CEO, AllMed Healthcare Management

Now more than ever, hospitals are under pressure to deliver the highest level of care while optimizing revenues and controlling costs.
Risk management departments are at the heart of this challenge, and top risk managers recognize that peer review can be a powerful too they can use if they fully understand it, embrace it, and advocate strongly for it as a proactive, ongoing initiative.

This was the focus of a recent online discussion convened by AllMed Healthcare Management, where more than 100 hospital risk managers learned how the integration of peer review and risk management is a best-practice step that can lead to performance improvement, reduced liability exposure, and fewer financial losses.

“Our primary message to these risk managers was that effective peer review has been proven to reduce negative financial consequences for hospitals and providers. It is a means for detecting and resolving physician practices that result in medical errors which lead to claims and lawsuits,” said Andrew G. Rowe, CEO of AllMed, a leading independent review organization (IRO) that works with hundreds of leading hospitals nationwide.

While most hospitals have peer review programs in place, Rowe said risk managers must actively work to overcome the deficiencies in these programs, any or all of which can lead to litigation risk and substantial claims costs. Among these deficiencies are the following:

  •     Peer reviewers often have conflicts of interest that reduce visibility to under-performing physicians
  •     Bylaws, policies and procedures regarding peer review often are not in place, may be unclear, or are not followed
  •     Many hospital peer review committees (PRCs) lack same-specialist expertise that often is necessary for the performance of certain physicians to be properly evaluated
  •     The voluntary nature of PRCs is such that meetings often are infrequently held, which slows down the review process
  •     Cases with negative outcomes may be suppressed or delayed to avoid conflicts, and medical executive committees (MECs) may fail to take action on identified performance deficiencies

According to Amy Marr, MD and associate medical director of AllMed, “risk managers can play a significant role in making peer review more effective. “ Actions they can take, she said, include advocating for regular assessment of the effectiveness and quality of the internal review process; evaluating litigation risk associated with peer review activities; providing regular visibility on claims costs to MECs and senior management; and working cross-functionally with quality, performance improvement and PRC leadership to improve peer review processes.

“Also, risk managers should insist on the development of and adherence to medical staff bylaws and policies; ensure that PRCs have defined structures and meet regularly; and should press for PRC training and documentation along with MEC and administrative oversight,” Marr added.

Adopting best practices in peer review requires that risk managers help overcome barriers to an effective process, including adopting the use of external peer review to complement internal programs. The key benefits of external review are fairness and objectivity, ready availability of same-specialist reviewers, and the reduced potential for internal organizational conflicts.

“In the end, where risk management is closely aligned with peer review – both internal and external – there is more likely to be improved care and patient safety, and less potential for expensive lawsuits or sanctions,” AllMed’s Rowe said.

About AllMed
AllMed Healthcare Management provides external peer review solutions to leading hospital groups and ASCs nationwide. AllMed offers MedEval (sm) and MedScore(sm), which help facilities improve physician performance through both periodic and ongoing case reviews at the individual or departmental levels. Services are deployed through PeerPoint®, AllMed’s state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at http://www.allmedmd.com

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Andrew G. Rowe

Bill Trainer
The Public Relations Project, Inc.
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