Author: Courtney Patterson

May 7, 2026

Posted on by Courtney Patterson

QUESTION:
Over the course of the past six months, three different physicians were recruited by our affiliated medical group who had significant issues – none of which were identified until they had applied for appointment and privileges at our hospitals.  And I mean big issues – one of the physicians didn’t even meet our threshold eligibility criteria because of a past licensure action!  We keep being told “they’ve been vetted already!” with lots of pressure to “get it done” when it comes to their credentialing.  We don’t know what they’re looking at in their “vetting” process, but it sure doesn’t seem to be what we’re looking at in credentialing.  Beyond the obvious waste of resources this is causing (both time and money!), it’s also starting to create serious strain between those of us involved in credentialing and the administrative team.  Is there a fix for this?

ANSWER FROM HORTYSPRINGER ATTORNEY LEEANNE MITCHELL:
First, if it helps you feel better, virtually every health system in the country is struggling with how to better align recruitment/employment and credentialing to avoid the very issues that your hospital is dealing with.  A big part of this problem is that for a very long time, the employment of physicians just didn’t exist, so now, we are trying to figure out how to best make these very different processes work together.

The other thing to understand is that when the individuals involved in recruitment say that these candidates have been “vetted” – they very likely have; however, the extent of information that is obtained in the standard employment process is very different than the extent (and type) of information we get in medical staff credentialing.  For example, while employers do verify past employment affiliations, an incredibly forthcoming employment reference will provide dates of employment and whether the individual is eligible for rehire.  That’s it.  And the vast majority only provide dates.  Recruiters tend to be astounded when they find out how much information we get in credentialing.  Unfortunately, that process – which is going to provide you with the much more detailed information – virtually always happens second (sometimes after contracts have been signed and money has changed hands).

So, is there a fix?  The perfect solution would be to not make any employment overtures until an identified candidate has been fully credentialed, which we also understand is impractical, and, frankly, just isn’t going to happen.  Short of that, given that it’s the employment screening or vetting that is occurring first, it’s vital to get everyone on the same page in terms of the qualifications that a physician must meet to be on your medical staff AND the types of “red flag” issues that might be identified in a candidate’s background that will, at the very least, slow down the credentialing process because they will require further review and which might end up being significant enough that the individual doesn’t make it through credentialing – whether that’s in the form of an application that remains incomplete because we can’t get sufficient information to resolve the concerns or through a denial.

We recommend that health systems sit down with their recruiters (whether internal or external) and explain exactly how the credentialing process works, what kind of information is requested, what primary source verification means and requires, what the hospital’s bylaws require, and what is typical in a healthcare provider’s background (and what isn’t).  Then, to go a step further and create recruitment screening tools for their recruiters to use very early on in the process of identifying candidates.  This tool should begin with the threshold eligibility criteria in the medical staff bylaws – with the recruiters understanding clearly that not meeting threshold criteria is a hard stop as no one can be guaranteed to get a waiver of such criteria.  Beyond threshold eligibility criteria, the screening tool should also identify significant red flags that are going to slow down the process – if for no other reason than for the employment side to be envisioning logical start dates (i.e., don’t think this candidate will be on the call schedule next week!).  So, for example, on the threshold eligibility criteria list may be that a candidate can’t have had a past licensure suspension in any state, while the red flag list includes having had terms of probation or conditions placed on a license in the past.

While not a perfect solution, ensuring that the recruiters understand the credentialing process itself and then the routine and consistent use of a more detailed screening tool can definitely help with these issues.

If you have a quick question about this, e-mail LeeAnne at info@hortyspringer.com.

April 30, 2026

Posted on by Courtney Patterson

QUESTION:
We have some pretty significant concerns about one of our new Medical Staff members.  We met with her and shared our concerns; she promised to do better, but didn’t.  This went on for several months and even after we tried a performance improvement plan, there was no sustained improvement.  Although we don’t often find ourselves in this position, we referred the matter to the MEC to consider whether to start an investigation.  The very next day, before the MEC had taken definitive action, the physician resigned her appointment and clinical privileges.

Now we’re not sure what to do.  Should we go forward with an investigation and confirm or negate our concerns?  Is her resignation reportable to the National Practitioner Data Bank as a resignation in return for not conducting an investigation?  How about a report to the State Medical Board?  We are worried about her clinical competence and afraid that if we don’t do something, she’ll hurt a patient at the next hospital where she lands.

ANSWER FROM HORTYSPRINGER ATTORNEY SUSAN LAPENTA:
We appreciate and share your concern about this physician moving to another hospital and perhaps hurting patients there.  The good news is that you have options on how to proceed in a balanced and fair way and, at the same time, make sure the next hospital has meaningful information so it can make an informed decision about credentialing and privileging this physician.

Let’s start with your first question about whether to go forward with an investigation so you can confirm or negate your concerns.  As it should, your question reflects that no final conclusions have been reached about the physician’s competence.  Obviously, you have serious concerns, and the purpose of an investigation would be to determine whether changes would need to be made to the physician’s privileges (e.g., limitation or revocation of some or all of her privileges).  However, since the physician resigned, this question is no longer relevant to the Medical Staff or the Hospital.

Even beyond this conclusion, it really is not possible to conduct a fair and balanced investigation once the physician has resigned and is no longer available to participate in the process.  Additionally, investigations, when done right, are quite time‑consuming for the members of the Medical Staff who are involved, including the members of the MEC and any members of the investigating committee.  Investigating a physician who has resigned is probably not the best use of your resources.  So, we are a definite “No,” in terms of starting and conducting an investigation of a physician who has already resigned.

The second question is whether the Hospital has an obligation to report this physician to the National Practitioner Data Bank (“NPDB”).  As you described, the MEC had not decided to commence an investigation.  (We will leave for another day, the language in the NPDB Guidebook that describes how the NPDB interprets the word investigation expansively.)

Hospitals are obligated to report the surrender of privileges in return for not conducting an investigation.  However, in this area, the Guidebook advises “A health care entity that submits a clinical privileges action based on surrender … [of] privileges while under investigation should have evidence of an ongoing investigation at the time of surrender, or evidence of a plea bargain.”  (Emphasis added.)  As you described the situation, there was no deal cut with the physician about resigning and, thus, we would conclude that the Hospital is not required to file a report with the NPDB.

Your third question, about whether there is an obligation to file a report with the State Board, will depend on your state law.  Some state reporting statutes follow the NPDB reporting; other states have more expansive reporting obligations.  We will have to check your state law.

Before we conclude, we want to get back to your concern about the physician moving to another hospital and perhaps hurting patients there.  Even without filing a report with the NPDB or the State Board, you can share your concerns about this physician when you respond to a request for a peer reference.  We recommend that you ask the physician to sign a specific authorization and release, including your proposed response.  If the physician refuses to sign a specific release, you can tell the requesting hospital that you are unable to respond because the physician has not authorized you to do so.  Along with protections available in your state peer review statute and your bylaws documents, this approach will help ensure you do not get sued in the first place for providing information to another hospital.  It will also serve as a red flag to the next hospital that they have more digging to do before granting the physician appointment and clinical privileges.

If you have a quick question about this, e‑mail Susan Lapenta at info@hortyspringer.com.

April 23, 2026

Posted on by Courtney Patterson

QUESTION:
Our hospital performs payor enrollment/delegated credentialing on behalf of healthcare insurers.  We were recently told during an insurer audit of our credentialing process that we have to include a question about race, ethnicity, and language on our application forms.  Is that correct?

ANSWER FROM HORTYSPRINGER ATTORNEY CHARLES CHULACK:
Yes.  The standards for the NCQA, one of the primary accreditation entities for insurers, that went into effect on July 1, 2025 included a new factor for practitioner applications.  The factor required the “application [to] include fields to enter race, ethnicity and language, and a statement that the organization does not discriminate or base credentialing decisions on an applicant’s race, ethnicity or language, and that providing the information is optional.”

In our work with clients, we understand that the NCQA and insurers are requiring these questions to be included on initial and recredentialing applications. Furthermore, the NCQA issued an FAQ on May 5, 2025 indicating that “[t]he requirement is for the application to have separate fields to enter responses for each of these three data points (race, ethnicity, and language).  However, it would be acceptable to group these into one question if the application prompts the user to provide separate responses for race, ethnicity and language.”

For more information about payor enrollment and delegated credentialing, join Horty, Springer & Mattern partners Charles Chulack and Lauren Massucci for the webinar The Nuts and Bolts of Delegated Credentialing – A “How To” for Organizational Providers on Implementing and Improving a Payor Enrollment Program, which will be available on our website on April 28, 2026.

If you have a quick question about this, e-mail info@hortyspringer.com.

April 16, 2026

Posted on by Courtney Patterson

QUESTION:
Our health system has been increasingly recruiting more foreign trained physicians.  However, our Credentials Policy requires that these physicians be either ABMS or AOA Board certified.  Although a temporary waiver may be issued in the interim, our system would still require that these physicians become Board certified in their respective specialties.  Given that they went to medical school in a different country and completed post-graduate training abroad, is that even possible?

ANSWER FROM HORTYSPRINGER ATTORNEY NICHOLAS CALABRESE:

Yes, this is possible and due to the increasing trend of foreign trained physicians practicing in U.S. hospitals, the ABMS and AOA Boards have created certain alternative pathways for internationally trained physicians.  The ABMS has published this chart which shows which member boards are open to foreign training.  As shown, almost 80% of the ABMS member boards do accept international training.  Unfortunately, that does not tell the whole story and the requirements for each individual board vary widely.  Certain boards offer partial credit to foreign trained physicians but still require them to be enrolled in an ACGME approved residency program.  Others have “exceptionally qualified candidate” programs which allow for such physicians who have completed three years of training outside the U.S. to apply for a fellowship.  After completing this fellowship, they may then sit for the board certification exam.

Overall, we haven’t found an ABMS member board that allows foreign trained physicians to get complete credit for their training and automatically sit for the certification exam.  Instead, your system must endeavor in a case-by-case analysis depending on the specialty that the foreign trained physician practices in to determine whether it would be feasible to require that physician to obtain ABMS certification.

If you have a quick question about this, e-mail info@hortyspringer.com.

April 9, 2026

Posted on by Courtney Patterson

QUESTION:
How is NASA monitoring the health of the Artemis II astronauts?

ANSWER FROM HORTYSPRINGER ATTORNEY
DAN MULHOLLAND:

According to Dr. A.I. Grok, NASA monitors the health of the Artemis II astronauts through a combination of dedicated flight surgeons, wearable and onboard sensors, scheduled self-performed tests, private medical conferences, and specialized experiments. Among other things, astronauts use Orion’s medical kit and perform checks. Key elements include:

  • Wearable sensors and actigraphy devices (part of the ARCHER experiment – Artemis Research for Crew Health and Readiness): These track movement, sleep patterns, activity, light-dark cycles, and team dynamics/behavioral data in real time or near-real time. They help assess performance, fatigue, and cognitive health.
  • Radiation monitoring: Crew members carry personal dosimeters (e.g., Crew Active Dosimeters in pockets) for real-time individual exposure tracking. Multiple active sensors inside Orion measure cabin radiation levels and can trigger warnings for solar particle events, allowing the crew to use shielding or shelter if needed. Cumulative doses on this short mission are expected to be low (roughly equivalent to a couple of CT scans).
  • Biological samples: Dry saliva swabs (easy to collect and store) measure stress hormones (e.g., cortisol), immune biomarkers, and other indicators at multiple points pre-, in-, and post-flight. Blood, urine, and other samples may also be collected for nutrition, cardiovascular, and immune studies.
  • Vital signs and physiological checks: Onboard equipment for blood pressure, heart rate, oxygen levels, ultrasound (e.g., artery scans), cognition tests, and vision assessments. The crew has practiced using the medical kit (thermometer, stethoscope, blood pressure monitor, etc.) and even demonstrated CPR in zero-g.

It is not clear if this is covered by the recent extension of the telemedicine waivers, but HIPAA precludes closure of their specific health information.  As a government agency that is not a covered entity, NASA is exempt from the HIPAA privacy rule, but it voluntarily complies with HIPAA with respect to astronauts’ protected heath information.

If you have a quick question about this, e-mail Dan Mulholland at info@hortyspringer.com.

April 2, 2026

Posted on by Courtney Patterson

QUESTION:
My wound care practice has been getting excellent results curing patient wounds, bed sores, and ulcers by using Bioengineered Skin Substitutes (“BSS”).  I realize that these BSS products are expensive, but they WORK!  Despite our excellent clinical results and after doing our best to follow Medicare’s confusing billing guidance, we were just informed by something called the local Unified Program Integrity Contractor (“UPIC”) that our use of the BSS was not medically necessary (despite the fact that the BSS cured the patients’ wounds) and are claiming that a significant refund is due the Medicare program.  Is this for real???

ANSWER FROM HORTYSPRINGER ATTORNEY HENRY CASALE:
Unfortunately, yes.  While it may be of little solace to you, a number of providers across the country are finding themselves in your exact situation.  Your only recourse is to refund the amount demanded or run the gauntlet of the Medicare’s appeals process.  But if you are going to appeal (and from the sound of your question you should), make sure you do so in time to avoid any recoupments taking place during the appeals process (to the extent that is possible).

You and other similarly situated legitimate providers are paying the price for Medicare’s lax oversight for the payment of BSS and some egregious actions by a few providers – who deserve whatever happens to them.

Medicare’s current shortsighted approach to BSS providers fails to recognize, what you already know from your clinical experience, that BSS when applied properly to suitable candidates is actually cost-effective care that reduces avoidable complications, including amputations, minimizes the need for acute care services, enhances patient care, patient quality of life, and patient satisfaction and allows a provider such as yourself to deliver high-quality, patient-centered wound care to the ever-increasing need for specialized wound care among the aging and medically complex populations suffering from complex wounds, bed sores, and ulcers.

First some background.  Medicare covers BSS, including some amniotic membrane allografts made from human placental tissue and even animal tissue like pork placenta. I know, sounds gross, but the way that these BSS work is that they are grafted to an open wound to cover the wound and the human placental tissue or animal tissue used in the BSS will assist with wound closure or skin growth, referred to as “scaffolding.” When used properly on suitable patients, BSS can provide really impressive improvement to horrendous wounds, bed sores, and ulcers that do not respond to traditional therapy.

So, the idea behind BSS is great, but they are EXPENSIVE.  The 2026 Physician Fee Schedule has an entire section devoted to payment for BSS.  That section of the Fee Schedule states that Medicare payment for BSS has increased 40 fold over the past several years, from $250 million in 2019 to over $10 billion in 2024.  So, Medicare drastically changed its coverage rules beginning January 1, 2026.  Many commercial insurers are even more restrictive in their coverage of BSS and you need to be sure to follow the rules of each insurer before submitting a claim for BSS.

The UPIC that you asked about conducts the first level of Medicare audit.  They are focused on BSS and seem to be hell-bent on demanding that providers repay the amount that has been paid to them by Medicare whenever and however they can.  They also have the right to begin to recoup the amount due on the claims at issue.  While you have 180 days to appeal the UPIC’s decision, if you do not file the first level appeal (called a Redetermination) with your local MAC within 60 days of receipt of the UPIC decision, Medicare will start recouping claims regardless of the validity of your argument on appeal.

Do not expect any relief from the MAC and again while you have more than 60 days to appeal the MAC’s denial, you must submit your Reconsideration Request to your local Qualified Independent Contractor (“QIC”) within 60 days of the MAC’s denial, or recoupment can begin.

The QIC is to make a decision within 60 days.  However, recently they have been running behind.  If the QIC takes longer than 60 days to make a decision, the QIC will write to you and give you the option to go directly to the next level of appeal – which is an Administrative Law Judge (“ALJ”).  While it is tempting to have your case heard by a supposedly independent administrative judge, please keep in mind that in the unlikely event that the QIC rules in your favor, the appeal to the ALJ will not be necessary.  But more importantly, in the event that you choose to appeal to the ALJ (or if there is an adverse decision by the QIC) then recoupment of the claims at issue can begin immediately – again regardless of the validity of your position that the claims for the BSS were medically necessary and submitted in accordance with Medicare’s coverage rules.

We hope you won’t need them, but there are two additional levels of appeal if the disputed claims are not resolved by the ALJ – an appeal to the Medicare Appeals Council Review and a review by the Departmental Appeals Board (“DAB”), and if that appeal is not successful you will have the right to seek judicial review by a federal district court, provided the amount in controversy is met (which in these cases it almost always is) – but you must exhaust all of these administrative remedies or the federal courts will not consider your appeal.

The other reason that Medicare is cracking down on BSS, is that due to Medicare’s past lax oversight of claims for BSS, certain people have been able to defraud the Medicare program for some REALLY BIG BUCKS.  We direct you to our next Episode of “The Kickback Chronicles” that will be entitled “A Grafting Grifter” and will be published on April 13 to learn about a situation that arose in Phoenix, Arizona where a couple of grifters were able to bill approximately $1.2 BILLION in false and fraudulent claims to health insurance programs for BSS, including submitting over $960 million in claims to the federal health care programs for BSS, of which, federal and state payers and commercial insurers collectively paid $614,945,420.

You will have to wait until April 13 to check out the next edition of The Kickback Chronicles in order to find out the details of their scheme, the lavish lifestyle they lived due to their ill-gotten gains, and what happened when it all came crashing down on them.

That kind of enforcement action we applaud.  What Medicare is currently doing to you, and to a number of other legitimate providers across the country who are using BSS to help their patients, is the real crime.

If you have a quick question about this, e-mail Henry Casale at info@hortyspringer.com.

March 26, 2026

Posted on by Courtney Patterson

QUESTION:
We are seeing Emergency Department wait times of several hours.  Can we post these wait times publicly, like, for example, online or at the entrance to the hospital?  And before a patient is formally logged in, can staff tell the person how long the wait is?

ANSWER FROM HORTYSPRINGER ATTORNEY FISHER FILIPPAZZO:

This is a great question and one that hospitals are asking with increasing frequency.  As a general rule, posting ED wait times should be approached with caution because of the potential implications under the Emergency Medical Treatment and Labor Act (EMTALA).  The concern is that publicly posting or verbally sharing estimated wait times may unintentionally encourage patients to “self triage” and decide to leave before receiving the medical screening examination required by EMTALA and needed by the patient.  The Federal Regulations and EMTALA Interpretive Guidelines emphasize that hospitals must not delay or discourage a patient from remaining for their medical screening examination.  (42 CFR 489.24 Tag A-2408/C-2408) Another concern with posting wait times is that these estimates also may not reflect sudden changes in acuity or patient volume.

Once an individual has arrived seeking care, it becomes even more sensitive.  While staff may answer a patient’s questions, proactively telling a patient the wait time or suggesting that they might prefer to seek care elsewhere can be viewed as discouraging them from staying.  That raises EMTALA risk.  Staff should focus on reassuring patients that they will be evaluated and treated.

Professional organizations, including the American College of Emergency Physicians (ACEP), have issued guidance for hospitals that choose to communicate wait times.  ACEP recommends that:

  • ED wait time be defined consistently as “door to qualified medical provider” time;
  • Disclaimers clarify that wait times do not apply to those with potentially life-threatening conditions;
  • Posted times be updated frequently and remain as accurate as possible; and
  • Public communication be accompanied by clear educational messaging so patients do not misunderstand their ability to receive timely care.

Overall, because of the EMTALA implications, posting or discussing ED wait times should be done very carefully, if at all.  If your hospital chooses to display wait times, make sure the information is accurate, updated regularly, and accompanied by appropriate disclaimers.  It is also important to reinforce that anyone with a potentially life-threatening condition will be evaluated immediately.

If you have a quick question about this, e-mail Fisher Filippazzo at ffilippazzo@hortyspringer.com.

March 19, 2026

Posted on by Courtney Patterson

QUESTION:
Your Question of the Week a few weeks ago provided a bunch of good tips for handling external reviews (that we had happily followed!), but it didn’t address one big issue our peer review committee is wrestling with right now.  Specifically, our committee arranged for an external review on a highly technical procedure that only one member of our medical staff performs that had resulted in a number of patient complications.  The issue that we are struggling with right now – with a difference of opinion among the committee members – is whether we need to show that report to the physician.  Some members of the committee think we will waive the peer review privilege if we do, while others disagree and say we have to show her to be fair.  Do we?

ANSWER FROM HORTYSPRINGER ATTORNEY LEEANNE MITCHELL:
In terms of waiving the peer review privilege, every state is different and you certainly should consult your legal counsel to make sure you are operating within the terms of what your state might require; however, it would be a rare/unusual statutory provision or court interpretation that would result in the peer review privilege being waived by a peer review committee sharing an external review with the physician whose care was being reviewed – when it is being done in order to allow that individual to provide additional input into the review.  That kind of interaction is at the heart of the peer review process itself.

Presuming waiver of privilege is not an issue, then yes, in order to be fair to the physician, we do strongly recommend that individuals whose care is the subject of an external review be given the opportunity to review those reports and to provide a response.  Ideally, this means that the report is provided to the individual in advance and the physician is given a period of time in which to review and provide a written response to the committee versus, for example, merely allowing the physician to review the report for the first time at the peer review committee meeting.  The goal of peer review is for the committee to have full and complete information before it makes a determination, and an informed and thoughtful response from the physician at issue is vital.

Sometimes, the concern that we hear raised is that the physician may contact the external reviewer, trying to lobby them to change their opinion, or even harass or threaten that individual.  If that is a concern, it can be addressed in advance by informing the physician that attempts to contact the external reviewer are inappropriate and would be assessed under the medical staff’s professionalism or code of conduct policy.  And in extreme cases, where the committee is truly concerned about the potential of such conduct, an alternative may be to provide a summary of the reviewer’s credentials and the body of the report only, deleting the external reviewer’s name and contact information – explaining why the committee took that step in the correspondence to the physician.

If you have a quick question about this, e-mail LeeAnne Mitchell at lmitchell@hortyspringer.com.

March 12, 2026

Posted on by Courtney Patterson

QUESTION:
This week’s question is taken from those submitted at the January 15-16, 2026 Complete Course for Medical Staff Leaders, held in Amelia Island.

Sometimes it’s very tempting to call a colleague you may know at another hospital to clarify the details of an applicant.  While I believe this is done routinely, is it legally permissible if the applicant has not declared this person a reference?

ANSWER FROM HORTYSPRINGER ATTORNEY RACHEL REMALEY:
As a general rule, it is perfectly acceptable (and appropriate) to contact anyone who may have any information that is relevant to an applicant’s qualifications.

This is America – so of course this has been litigated.  Check out what the United States District Court for the District of New Jersey said in this 2014 case (where a physician alleged wrongdoing by a Credentials Committee chair, who contacted individuals not listed by the applicant on her application):

“As to [the Credentials Chair’s] request for information from non‑references…affirmative contact with these individuals, that is, without prior clearance for such action from Dr. Pal, reflects a diligent and comprehensive investigation in connection with her application for privileges…”

Pal v. Jersey City Medical Center (D.N.J. Oct. 24, 2014)

So, who can you contact?  Anyone who may have information about the applicant’s clinical skill, experience, training, professional conduct, health status, etc.  You likely have a statement in your Medical Staff Bylaws and on your Medical Staff application forms that states something to this effect (virtually all organizations do).

The “usual suspects” for affiliation verifications/references include other health care facilities where the applicant is employed or has been employed, or has held medical staff membership or clinical privileges.  Department chairs from current and previous organizations, as well as residency program directors (if recently out of training), and current and past employers are also often contacted.

But, what about a nurse supervisor at a facility that has reported interpersonal conduct issues by the practitioner?  What about the applicant’s arresting or probation officer?  An ex-wife who filed a restraining order?  Yes to all of these!  Anyone who may have information relevant to the qualifications of the practitioner to be a medical staff member (including maintaining orderly operations of the hospital) or to exercise privileges (including anyone who may have information about health status, reliability, clinical performance, education, training) can be contacted and asked for information.

To get back to your question – you specifically asked whether you can contact a colleague you know.  Of course (as noted above), the answer is yes (we really do mean anyone who may have information about the applicant, including anyone who may be able to share real life observations or other information).  But, here’s the kick – whenever you request and/or obtain information about an applicant, that should be documented in the credentialing file.  Therefore, before you call in a personal favor to a friend, realize that your contact with that individual needs to be documented in the file and anything they tell you will not be “off the record.”

So, if you plan to contact a personal friend, acquaintance, or colleague to request information, remember to treat the contact and request with the same formality that you would treat other requests.  If you are asking for important information, trying to clear up concerning rumors or verify whether the applicant has made a misrepresentation, etc., it may be best to make the request for information in writing (and to supply a copy of any authorization/release that your applicant has signed).

Never promise that information revealed to you will be kept secret (this is a promise you cannot keep!).

And, if your friend/colleague holds a leadership position at another facility (e.g., they are the chair of credentials or department chair at the facility where the applicant recently held privileges), remember that they have legal obligations of confidentiality with respect to their proceedings as medical staff leaders and when they act in those roles they are agents of the facility.  Accordingly, it may be best in those cases to direct your request to the facility itself, rather than the individual (so that the individual is not put in a difficult position).

If you have a quick question about this, e-mail Rachel Remaley at rremaley@hortyspringer.com.

March 5, 2026

Posted on by Courtney Patterson

QUESTION:
There is a new GI on our staff who had a concerning number of complications during his initial focused professional practice evaluation.  To make sure our process was completely objective, we decided to get an external reviewer to evaluate some of the cases with complications.  Instead of sending all of the cases of concern, we sent a sample which reflected the various kinds of complications the GI had during his first eight months of practice.  We thought this would allow us to expedite the review and save a little money at the same time.  Is this ok?

ANSWER FROM HORTYSPRINGER ATTORNEY SUSAN LAPENTA:
Obviously, you’ll want to review and follow your peer review policy.  In our experience, most peer review policies would not be detailed enough to address your question and thus you should have some flexibility to decide which cases you want to send for external review.  You are correct that the cost of the external review will increase with the number of cases and the length of time it takes to get the report back may also increase with the number of cases.  Those are relevant practical considerations.  At the same time, you may want to send enough cases so the external reviewer is able not only to comment on the individual case but also whether there is a pattern or trend of care that might be concerning.

You can also stage the review, starting with a smaller sample size and then adding additional cases if you want the reviewer to address the broader question of whether there may be a pattern of concerning care.  It can often be helpful to provide the reviewer with information about the physician’s overall case volume and complication rate.  You should also not hesitate to confer with the external reviewer after they have provided you with their report.  These meetings can often be very instructive, especially if concerns have been confirmed in the report, to help you frame and implement remedial actions.

The bottom line is you want to make sure you follow your peer review policy.  At the same time, you probably have a lot of flexibility and discretion in deciding how many and what kind of cases to send to the external reviewer.  If you have a lot of cases of concern, you may want to stage the review to make sure you are getting the most out of the review.

If you have a quick question about this, e-mail Susan Lapenta at slapenta@hortyspringer.com.