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.