Resources and Case Studies
Ensuring the Cost Effectiveness of External Peer Review
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:
These six techniques have proven to be successful in ensuring the cost-effectiveness of EPR:
External Peer Review Mechanics
CASE STUDY #1: The Value of Objective Legal Counsel Review to Identify the Precipitant for the External Review.
The performance of a hospital employed gastroenterologist was questioned by some complaints over the past several years with little or no investigation or follow up. In February 2016 the GI Nurse Manager went to the VP of Nursing about the physician to complain that he did colonoscopies on patients with poor preps, too fast, and documented scopes to the cecum when this didn’t happen. The VP of Nursing brought this issue to the attention of the Chief Quality Officer (CQO) and the Chair of the Medical Staff Quality Committee (MSQC).
CASE STUDY #2: MSP’s Businesslike and Professional Coordination of the Risk Management & Peer Review Process that satisfied the Patient’s concerns
Carefine Hospital’s internal Peer Review Committee (PRC) reviewed a patient case referred from the risk management department based on a patient complaint. They found the care by the physicians and nursing/therapy staff to be appropriate. The Director of Quality/Risk Management Department was concerned that the CMO and VP of Patient Services communication with the patient was not satisfying the patient’s concerns. The CMO asked the Medical Staff Professional (MSP) to objectively review the case and make suggestions. The MSP reviewed the entire case review up to that point. She identified the real issues were:
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
CASE STUDY # 4: Don’t over react over sample: Confirm physician competency and program quality effectively and efficiently
Midwest Rehabilitation Hospital started a new Wound Care Service (WCS) to complement their expanding ambulatory orthopedic surgery initiatives in April of 2015. At the February, 2016 MEC meeting the Chair of Orthopedic Surgery indicated that a 5 member private orthopedic group complained to him about the quality of care their patients had been receiving from the general surgeons staffing the WCS. The orthopedic group requested that all of the 78 patients they had referred to the WCS be reviewed for appropriateness by an objective outside physician reviewer as the WCS surgeons were either employed by the hospital or in a competing group practice. The MEC directed the Orthopedic Chair to work with the CMO in determining an appropriate review.