Case Study #3: Conflict of Interest and Competition and lack of exact match in reviewer qualifications cause redo of EPR

HeartLove Hospital Peer Review Committee (PRC) had a Board Certified cardiologist from a private multispecialty group perform an external review of eight (8) CTA Heart images for completing Focused Professional Practice Evaluation (FPPE). The PRC was verifying the competency of a hospital employed cardiologist who was recently granted a new privilege to do CTA Heart with 3D imaging (Heart CT) at the HeartLove Hospital. The hospital employed cardiologist is Board Certified by the American Board of Internal Medicine in Cardiovascular Disease and has completed the Certification Board of Cardiovascular Computed Tomography (CBCCT) examination in June 2016.

The private multispecialty cardiologist, who was not certified in Heart CT and was critical of the Heart CT interpretations, would not put his opinions in writing other than to indicate on the internal peer review form that 5 of 8 interpretations were questionable. He would not give specific reasons.

The PRC obtained a second external review performed with an ABIM board certified, CBCCT cardiologist experienced in heart CT who re-read the exact same 8 Heart CT interpretations and completed a comprehensive evaluation report (commenting on physician knowledge, judgment, technique, documentation) for each heart CT. The physician consultant’s findings and conclusions indicated: "Given the fact that only 8 images were reviewed, the conclusions of this review in no way reflect on the total quality of care provided by the physician being reviewed. However, a generally recognized acceptable standard of care was met in the images reviewed.” The PRC received confirmation of acceptable care being provided, and recommended continuing privileges to the MEC. They also adjusted their approach to avoid conflict of interests and to seek an exact match relative to the credentials of the external reviewer with the physician being reviewed.