QUESTION:
In our professional practice evaluation process, we sometimes adopt a performance improvement plan (“PIP”) that includes proctoring, second opinion consultations, and/or prospective case review.  In our PIPs, we try to include the kind and the number of cases that have to be reviewed.

The last several times we have done this, however, the physician stopped practicing at the hospital and never completed the PIP. This has become an issue at reappointment.  Any suggestions??

ANSWER FROM HORTYSPRINGER ATTORNEY SUSAN LAPENTA:
This is a great question, and it is an issue we see quite a bit.  We have a couple of suggestions for your consideration.  In addition to the number and kinds of cases to be reviewed, it is a good idea for the PIP to include a time frame for its duration.  So, for instance, the PIP might say something like this:

For at least the next ten major gynecology procedures you perform at the Hospital, you must arrange to have a proctor who has clinical privileges to practice at the Hospital (“Proctor”) and who has been approved in advance by the Chair of the Peer Review Committee or the Chief Medical Officer.  The Proctor must be present in the OR before the case is started and must remain in the OR for the duration of the case.

For at least the next six months, the Peer Review Committee will conduct a retrospective review of your major gynecology procedures to evaluate compliance with each element of the PIP.  The Peer Review Committee will share the results of the review with you, and you will be invited to provide input.

At the end of six months, the Peer Review Committee will review the results of the PIP and meet with you to discuss them.  Thereafter, it will recommend whether the PIP has been successfully completed, whether it should be continued or modified, or whether some action consistent with the Medical Staff Bylaws or other Medical Staff rules or policies should be considered.

Although we don’t always include this in the original PIP, you raise a great question about a practitioner who agrees to the PIP but who then fails to actively participate in or complete it.  If you find yourself in this situation, where after the initial term of the PIP, the practitioner has not had any, or very few cases completed, you could adopt a revised PIP with language like this:

It has been more than six months since you agreed to abide by the PIP.  Critically, you have failed to complete any of the clinical components outlined in PIP.  Specifically, you were required to have 10 ten major gynecology procedures proctored.  To date, you have not performed any of these cases.  Therefore, this Revised PIP will be in effect for an additional six months.  If you fail to complete the PIP at that time, such will be accepted as a voluntary resignation of your appointment and clinical privileges.

It is also very important to refer to the PIP if the practitioner is reappointed during its term. Too often, a standard reappointment letter will be sent to a practitioner who is subject to a PIP.  This is not only a missed opportunity to reinforce the existence of the PIP, but it also sends very mixed messages.  So, make sure the department chair, Credentials Committee, Medical Executive Committee, and Board have access to the PIP when they are making reappointment decisions.  The reappointment letter is a perfect place to reinforce the terms of the PIP and provide notice of consequences if the terms of the PIP are not timely completed.

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