Ensuring the Cost Effectiveness of EPR

​Many medical staff professionals (MSPs) and medical staff leaders throughout the country have identified the following techniques and initiatives as useful for reducing the cost of obtaining EPR.
These six techniques have proven to be successful in ensuring the cost-effectiveness of EPR:

1. MSPs should have a predetermined agreement with individual peer reviewers, hospitals located in other geographic areas within the state and/or with consulting/EPR firms. Pre-negotiated professional fees can be achieved through the use of a request for proposal when time is not a factor in obtaining an expedited review. MSPs are often under pressure to confirm the competency of a physician requesting privileges for a new procedure or to use new equipment. A predetermined agreement can expedite the review at your particular hospital when no other medical staff member has the privilege to use that procedure or new equipment.
2. Minimize the number of cases that an external peer reviewer has to review. MSPs and quality improvement (QI) directors know that this is best accomplished by clearly defining what concern needs to be addressed. In doing so, the number of cases needed to answer that concern will be specific to the purpose of the review. Of course, it may depend upon the number of problem cases available. Sometimes, it may be just one case that needs evaluation. The review can always be expanded easily, depending on the results of the initial review.
3. Use more contemporary ways to communicate.Use conference calls to review and confirm the external physician’s or organization’s qualifications, methodology, case selection and sample size, as well as the results of the review. Often hospitals or group practices pay for on-site visits to review the results and conclusions of the clinical review report, but MSPs report that telephone or web conferences are usually a far more timely way to communicate as well as more cost-effective.
4. Review case selection and methodology with the physician(s) being reviewed in advance, if possible. This will increase the potential acceptance of the reviewer’s conclusions.
5. Ensure that the hospital, external review consulting firm, and/or the individual physician reviewer does not put another person between the reviewer and the medical record. By that, we mean that the peer reviewer should receive the entire medical record, supporting documents and films without these items being pre-screened/filtered by a non-physician. Pre-screening may leave out key parameters that impact the clinical reviewer’s conclusions and lead to an erroneous result.Prescreening and sending only portions of a medical record may be appropriate when doing a focused review to answer a specific question or concern.
6. It is usually not cost-effective to ask the clinical reviewer to recommend corrective actions. In other words, respect the boundaries between peer review and corrective action. Make sure that the reviewer clearly states his or her conclusions. MSPs should obtain a pre-review agreement on the methodology and reporting. Many medical staffs receive vague conclusions from a first review and have gone on to get one or two more reviews to try to clarify the initial EPR evaluation. Multiple EPRs are costly! MSPs should have the external peer reviewer provide comments regarding the care rendered in each case and leave recommendations regarding corrective actions to the medical staff leadership as required by the medical staff bylaws, rules and regulations, and EPR policy.

MSPs, in collaboration with the vice president of medical affairs (VPMA) and the QI director, are often the point persons for identifying and arranging the resources for performing EPR after the quality improvement/peer review process has identified the need for EPR. It is hoped that MSPs will use and/or instruct their leaders with these suggestions for enhancing cost effectiveness and improving the timeliness of EPR.
These are practical lessons learned from the field that will save the medical staff leaders, the individual being reviewed and their organizations much time, money and effort when performing EPR.