Question:

I attended The Peer Review Clinic in Monterey, California in November. We are in the process of revamping our process based on your recommendations.  The faculty recommended not using a scoring system for peer review cases. If a scoring system is not used, how should we report the results of the process?

Answer:

We do not recommend incorporating a scoring system into the peer review process for several reasons.  Our experience has been that when a scoring system is used, the score given to a case becomes the whole focus of the process, as opposed to identifying whether there is, in fact, a concern with the care provided in a particular case and determining the appropriate intervention to address that concern.

In addition, scoring systems often include descriptors from “standard of care met” to  “standard of care not met,” to “serious deviation from standard of care,” or sometimes even “unexpected and catastrophic adverse patient outcome due to care.”  Hopefully, the state peer review statute would protect those findings from discovery in a malpractice case but if they were discovered or admitted, they would be very detrimental.  In addition, most physicians would be very uncomfortable applying such a description to the care rendered by a colleague. Thus, too often, the outcome of reviews is not to take any action or intervention but to continue to “trend” to see if a pattern develops.  Unfortunately, that forfeits an opportunity to help a colleague improve his or her clinical practice and may put patients at risk.

Rather than reporting “scores,” consider developing reports for individual practitioners and for departments that reflect the reasons that cases are reviewed, the findings of the reviewers and the final determination or the interventions implemented – “No further review required,” “Educational letter,” “Collegial intervention,” or “Performance Improvement Plan.”  Such reports are more informative than those that simply report scores.  Samples of such reports are available on our website.

(The Peer Review Clinic will be offered March 1-3 in Washington, D.C. and April 12-14 in Chicago.  More information is available here.)

Question:

How high can you set your threshold criteria for appointment? Clearly, a license to practice medicine in the state is required. Can you require an unrestricted license? Can you require that the physician’s license has never been restricted?

Answer:

As the practice of medicine becomes more complex, specialized, and hi-tech, many hospitals and their medical staffs have taken steps to strengthen the qualifications for medical staff membership and clinical privileges. Detailed objective criteria leave less room for subjective determinations that are more likely to be subject to legal challenges.

It is our experience that beyond even the most basic criteria such as completion of an accredited residency and maintenance of board certification, medical staffs have been implementing more stringent objective criteria, such as evidence of an “unrestricted” medical license that has never been suspended or revoked by any state agency; “unrestricted” professional liability insurance coverage; “unrestricted” DEA registration and state controlled substance license; no conviction of Medicare, Medicaid, or other federal or state governmental fraud or program abuse; no exclusion or preclusion from participation in Medicare, Medicaid or other federal or state governmental health care programs; no conviction of any felony or of any misdemeanor relevant to Professional Staff membership; and no adverse professional review action regarding appointment to the Medical Staff or clinical privileges by any health care facility for reasons related to clinical competence or professional conduct.

By incorporating these standards with the concept of eligibility, applicants who do not meet them are not “denied,” but, rather, are informed that they are not eligible to apply to the Medical Staff.To learn more about these and other credentialing standards that promote greatness, please join the attorneys of Horty, Springer & Mattern for their newest audio conference series entitled “Grand Rounds: Information Doctors Can’t Afford to Miss.” These 1-hour presentations will be held on the first Tuesday of every month and are designed with even the busiest physician’s schedule in mind. And, best of all, each live audio conference includes 1 CME credit! Click here to learn how you can participate and how you can save when you purchase the 12 conference series. The first audio conference, Cream of the Crop: Credentialing Standards That Promote Greatness, will be held January 3.