PEER REVIEW BEST PRACTICES WITH PAUL VERARDI – THE DEEP DIVE

Dates

Part 1

PEER REVIEW BEST PRACTICES WITH PAUL VERARDI –
THE DEEP DIVE

March 4, 2021

1:00 – 3:35 PM ET

Part 1  —  Foundation for PPE Success:  Purge the Past, Incorporate Four Top Principles That Promote Modern and Effective PPE, and Establish Two New Medical Staff Committees That Are Game Changers!   

_
The two sessions in Part 1 of the Series cover the following:  (Total Time – 2:18)*

Session 1:    This session analyzes and provides guidance regarding four essential building blocks that form the foundation for a successful PPE process:

• The specific terminology and tone that you use are critical to removing traditional barriers and promoting collegiality;

• “Scoring” (or leveling or grading) is the single most destructive component in many peer review processes;

• There is an art to obtaining input from a colleague about a clinical or conduct issue (as well as knowing what to do if your colleague refuses); and

• Take several, simple – but impactful – steps that continuously reinforce the three major goals of modern clinical PPE and tangibly demonstrate that the process is not “anti-physician,” but rather “pro-patient!”

_
Session 2:    A modern Medical Staff needs to have a “Leadership Council”… and an empowered “CPE” (Committee for Professional Enhancement).  If you don’t, respectfully, you are behind the curve a bit and using older tools and older thinking when trying to perform this most important work of the Medical Staff.  This session discusses the rationale for both committees and how they function.  It also reviews specific recommended Bylaws language that outlines the composition and duties for these two centerpieces of a constructive and effective PPE process.

_
Supplemental Resources for Session 1:

1. Slide Text
2. Practitioner History Report
3. Letter Seeking Input (Clinical Issues)
4. Automatic Relinquishment Letter (Clinical Issues)
5. Letter Seeking Input (Conduct Concerns)
6. Automatic Relinquishment Letter (Conduct Concerns)
7. PPE Clinical Activities Report – Option 1 CSR Interventions
8. PPE Clinical Activities Report – Option 2 CSR No Interventions
   _

Supplemental Resources for Session 2:

1. Slide Text
2. Sample Bylaws Language Regarding the Leadership Council
3. Sample Bylaws Language Regarding the Committee for Professional Enhancement
4. CPE Case Review Algorithm

Part 2

PEER REVIEW BEST PRACTICES WITH PAUL VERARDI –
THE DEEP DIVE

March 11, 2021

1:00 – 3:25 PM ET

Part 2  —  Significantly Enhance Your Clinical Review Process, Empower Your Case Reviewers with Training and Tools (It Is an Acquired Skill!), and Promote Education for All

The two sessions in Part 2 of the Series cover the following:  (Total Time – 2:07)

Session 3:    This session takes a step-by-step walk through our recommended clinical review process, which we have developed through our work with hundreds of Medical Staffs.  As part of the journey, we address critically important issues, such as how to handle the “employed physician” conundrum,  the benefit of utilizing “Informational Letters” to provide quick and non-threatening feedback, the different options that are available for obtaining necessary specialty expertise, and why the MEC should have no involvement in day-to-day performance issues!

_

Session 4:    Reviewing cases is an entirely acquired skill!  This session provides detailed training for your physician reviewers and helps them effectively and efficiently perform their responsibilities.  As part of the session, we carefully review our recommended Case Review Form (which is also provided in the supplemental materials), and we empower your physicians with a discussion of all the legal protections available to them when they share their expertise as part of PPE activities.

Supplemental Resources for Session 3:

1. Slide Text
2. Flowchart of Recommended PPE Process (Option 1)
3. Flowchart of Recommended PPE Process (Option 2)
4. Flowchart of Recommended PPE Process (Option 3)
5. Flowchart of Recommended PPE Process (Option 4)
6. CPE Case Review Algorithm
7. Sample Performance Issues That Trigger Informational Letters
8. Sample Informational Letter
   _

Supplemental Resources for Session 4:

1. Slide Text
2. Case Review Form (Option 1)
3. Case Review Form (Option 2)
4. Case Review Form (Option 3)
5. Case Review Form (Option 4)
6. Release Language to Be Included on Application Forms
7. Confidentiality Agreement for Medical Staff Leaders
8. Letter Seeking Input (Clinical Issues)
9. CPE Case Review Algorithm

Part 3

PEER REVIEW BEST PRACTICES WITH PAUL VERARDI –
THE DEEP DIVE

March 18, 2021

1:00 – 3:35 PM ET

Part 3  —  There Has Been No Bigger Sea Change (and for the Better!) than in the Areas of Professionalism and Practitioner Health – Catch the Wave!

The two sessions in Part 3 of the Series cover the following:  (Total Time – 2:18)

Session 5:    Because of advancements in thinking and tools, “behavior” concerns have become the easiest performance issue for a Medical Staff to manage.  This session explains why the traditional approach of having Department Chairs or Medical Staff Presidents take the lead on these issues is not effective.  It then outlines a recommended step-by-step process to use, which has the Leadership Council at its core.  As part of the discussion, the session addresses important issues such as how to appropriately respond to individuals who report concerns, when it is appropriate to use simple “awareness interventions” with colleagues with no formal fact-finding, and the need to be wary of psychiatric evaluations in this context.

_

Session 6:    An increasing number and variety of “health issues” are arising on modern Medical Staffs.  Once again, a Leadership Council is a game changer when it comes to effectively and compassionately addressing them.  This session gives specific and concrete advice on provisions that need to be in your Practitioner Health Policy in order to appropriately address the difficult issues that arise.  These issues include what to do if you are confronted with an immediate issue that might pose a threat to patients or staff (a suspension should be your last choice!), how to obtain credible and appropriate health assessments and utilize that information in reinstatement determinations, and how to manage health issues at the time of reappointment (we recommend a non-traditional approach, but also very effective!).

Supplemental Resources for Session 5:

1.  Slide Text
2.  Flowchart of Recommended Process for Reviewing Conduct Concerns
3.  Sample Appendix to Policy – Examples of Unprofessional Conduct
4.  Response to Individual Who Reported Concerns about Conduct
5.  Form to Document Resolution of Minor Concerns
6.  Letter Seeking Input Regarding Conduct Concerns
7.  Confidentiality and Non-Retaliation Agreement
8.  Automatic Relinquishment Letter for Failure to Cooperate
9.  Policy Language Regarding No Attorneys or Recordings at Meetings
   _

 Supplemental Resources for Session 6:

1.  Slide Text
2.  Flowchart of Recommended Process for Reviewing Health Concerns
3.  Health Issue Reporting Form
4.  Automatic Relinquishment Letter for Refusal of Testing When There Are Immediate Concerns
5.  Talking Points for Meeting with Practitioner about Health Issue
6.  Consent for Disclosure of Information and Release from Liability
7.  Authorization for Release of Protected Health Information
8.  Health Status Assessment Form

Part 4

PEER REVIEW BEST PRACTICES WITH PAUL VERARDI –
THE DEEP DIVE

March 25, 2021

1:00 – 3:20 PM ET

Part 4  —  OPPE, FPPE to Confirm Competence and Professionalism, and Addressing Medical Necessity and Utilization Concerns Are Essential Components of Modern PPE

The two sessions in Part 4 of the Series cover the following:  (Total Time – 2:04)

Session 7:    These are common statements that we hear:  “OPPE Data Elements must address each one of the six ACGME general competencies.”  “A Department Chair must review and sign off on every individual OPPE Report.”  “A partner cannot be used to proctor a new member of our Medical Staff because of the conflict of interest.”  And each of these statements is incorrect.  Although the OPPE and FPPE to Confirm Competence processes have been in hospitals for over a decade, there is still much misinformation out there and, as importantly, far too few Medical Staffs that perform these functions well.  This session outlines our recommended step-by-step processes, which include a number of practical (albeit non-traditional) suggestions that have worked extremely well for many Medical Staffs.

_

Session 8:    There are three, discrete “medical necessity and utilization” issues that  commonly arise on Medical Staffs.  This session identifies them and provides guidance on how each one should be addressed as part of your PPE processes.  Particular attention is given to medical necessity and appropriateness concerns because they not only represent poor care, but also create acute legal risks in terms of fraud enforcement activities and malpractice suits.  Another important focus is how to take steps to revitalize your UR Committee so that it is no longer the “Rodney Dangerfield” of committees as is the case on many Medical Staffs!

Supplemental Resources for Session 7:

1. Slide Text
2. Flowchart of Recommended OPPE Process
3. Notice to Practitioner – All Data Within Expected Performance Parameters
4. Notice to Practitioner – Some Data Not Within Expected Performance Parameters
5. Form to Document OPPE Review of Practitioners
6. Flowchart of Recommended FPPE to Confirm Competence and Professionalism Process (New Members/New Privileges)
7. Retrospective Chart Review Form
8. 360 Review Form
9. Memo Regarding Proctoring for FPPE to Confirm Competence and Professionalism
10. Proctoring Review Form
    _

Supplemental Resources for Session 8:

1. Slide Text
2. National Hospital Discharge Survey
3. Policy Language Regarding Professionalism Surrounding UR Issues
4. Flowchart of Recommended Processes for Reviewing Medical Necessity and Utilization Issues

Part 5

PEER REVIEW BEST PRACTICES WITH PAUL VERARDI –
THE DEEP DIVE

April 1, 2021

1:00 – 3:45 PM ET

Part 5  —  Let’s Get Better at “Fixing” Performance Issues When They Are Identified – Top Tips for Conducting Successful “Collegial Counseling” Sessions and Developing Successful “Voluntary Enhancement Plans”

The two sessions in Part 5 of the Series cover the following:  (Total Time – 2:31)

Session 9:    Just like reviewing cases, conducting an effective and successful “collegial counseling” session is an acquired skill!  This session is based on lessons learned from many Medical Staff leaders who have conducted these sessions well over the years.  Let’s stand on the shoulders of those giants who have come before you and review their practical guidance.  This session focuses on how to carefully plan these sessions in advance and how to document them afterwards – all with the goal of being “one and done!”  We also touch on the related issue of where the documentation of these efforts should live and whether your colleague who was the subject of the session has access to it.  (Hint:  Have a clear policy on this!)

_

Session 10:  In many traditional “peer review” processes, if a pattern of care or conduct develops after trying educational letters and collegial chats, the matter is immediately referred to the MEC to manage under the Bylaws documents.  We are lobbying you to break from this tradition!  This session focuses on how the CPE and Leadership Council can develop “VEPs” (Voluntary Enhancement Plans) that address the more significant clinical and behavior issues and that actually work!  We list and discuss the most common VEP options that should be contained in your policies.  We also focus on the two essential keys to VEP success: (i) tone, tone, tone with all of your communications!, and (ii) you must be very explicit on the details and expectations for your colleague who agrees to the VEP.  Developing this VEP expertise and using the tools provided will be good for your colleague being reviewed, the Medical Staff leaders, and – most importantly – your patients and staff!

Supplemental Resources for Session 9:

1. Slide Text
2. Collegial Counseling Checklist
3. Template Follow-Up Letter to Collegial Counseling Number 1
4. Template Follow-Up Letter to Collegial Counseling Number 2
5. Policy Language Regarding No Attorneys or Recordings at Meetings
6. Request to Access Confidential File Form
   _

Supplemental Resources for Session 10:

1. Slide Text
2. Template Letter for Voluntary Enhancement Plan (Clinical Issues)
3. VEP Options – Implementation Issues Checklist (Clinical Issues)
4. Memo Regarding Second Opinions/Consultations
5. Second Opinion/Consultation Worksheet
6. VEP Options – Implementation Issues Checklist (Conduct Issues)
7. Directory of Physician Assessment and Remedial Education Programs

Part 6

PEER REVIEW BEST PRACTICES WITH PAUL VERARDI –
THE DEEP DIVE

April 8, 2021

1:00 – 3:00 PM ET

Part 6  —  Effectively Manage the Conflict of Interest Situations That Routinely Arise on Every Medical Staff (the Traditional Way Simply Doesn’t Work!) and Then Participate in an Extended “Anything Goes” Q&A Session with Paul!

The two sessions in Part 6 of the Series cover the following:  (Total Time – 0:58 + Q&A)

Session 11:  Conflicts of interest arise on every Medical Staff and often confound the Medical Staff leaders who need to manage them.  The problem is that the traditional approach to this difficult area is incredibly unhelpful to busy clinicians.  Medical Staff leaders are often asked to figure these situations out in an ad hoc manner, every single time they arise…and yet be consistent as well.  This session breaks down and simplifies this complex area and provides you with a very non-traditional – but very effective – tool for your Medical Staff to incorporate into your Medical Staff Bylaws and PPE Policies.  Basically, we have applied the rules to the most common COI scenarios that arise during PPE activities and have given you the answers on an easy to follow matrix!  We also provide very specific guidance on how to implement and document an appropriate “recusal” from participation in the rare times that is necessary.

_

Session 12:  This final hour of the seminar (or more if necessary!) is devoted to an  extended live Q&A session with Paul.  This session is truly “Anything Goes” and Paul is very happy to discuss any recommendations that have been presented during the seminar series, address any questions or provide clarifications regarding any of the significant supplemental materials, or weigh in on any “hypothetical” scenarios from your world!

Supplemental Resources for Session 11:

1. Slide Text
2. COI Matrix (Which Includes Rules for Recusal)
3. Bylaws Language That Supplements the COI Matrix

Faculty

Paul Verardi

For over 30 years, Paul has devoted his entire practice to Medical Staff matters.  He has worked extensively with Medical Staff leaders from across the country on a wide variety of credentialing, privileging, peer review, and investigation matters, as well as on the review and revision of Medical Staff Bylaws and the redesign of peer review systems in order to make them more constructive, educational, and effective.

More Information >>

Learning Objectives

Learning Objectives

PART 1:

Session 1:  Four Top Foundation Principles for PPE Success!

Upon completion, participants will be able to:

• • • Identify the four top foundation principles for PPE success and incorporate them into the Medical Staff’s PPE processes
    • Identify several traditional elements contained in most peer review systems that generally condemn those systems to ineffectiveness and inefficiency, and eliminate them from the Medical Staff’s systems
    • Utilize best practice tips and tools for effectively obtaining input from a colleague when clinical or behavior concerns have been identified.

Session 2:  A “Leadership Council” and “CPE” (Committee for Professional Enhancement) Are the Centerpieces of Modern and Constructive PPE.

Upon completion, participants will be able to:

• • • Identify the two Medical Staff committees that are essential for modern and constructive PPE and incorporate them into the Medical Staff Bylaws and related policies.
    • Describe the recommended composition, role, and reporting responsibilities of a Leadership Council.
    • Describe the recommended composition, role, and reporting responsibilities of a Committee for Professional Enhancement.

PART 2:

Session 3:  Step-By-Step Process for Addressing Clinical Concerns.

Upon completion, participants will be able to:

• • • Describe the legal, regulatory, and human costs of failing to do clinical “peer review” in an appropriate manner.
    • Implement a step-by-step “best practice” review process for addressing clinical concerns in a consistent, effective, and constructive manner.
    • Revise Medical Staff Bylaws and policies to reflect the modified role of a Medical Executive Committee in modern PPE activities.

Session 4:  Reviewing Cases Is an Acquired Skill – Empower Reviewers with Training and an Effective Case Review Form

Upon completion, participants will be able to:

• • • Identify the several different options for obtaining specialty expertise in the review of a clinical concern and select the option that best fits a particular Medical Staff’s culture.
    • Describe the various legal protections that are available for Clinical Specialty Reviewers and incorporate language in Medical Staff Bylaws and application forms that strengthens those protections.
    • Utilize a carefully drafted Case Review Form to promote the appropriate assessment of clinical issues and concerns, the identification of educational lessons learned, and the identification of system issues that also impact patient outcomes.

PART 3:

Session 5:  Step-By-Step Process for Addressing Behavior Concerns

Upon completion, participants will be able to:

• • • Implement a step-by-step “best practice” review process for addressing professionalism concerns in a consistent, effective, and constructive manner.
    • Utilize a standardized script and tool to respond to any individual who reports a concern regarding professional conduct.
    • Incorporate several provisions into Medical Staff Bylaws and related policies that promote the timely, collegial, and constructive resolution of behavior concerns.

Session 6:  Step-By-Step Process for Addressing Health Concerns

Upon completion, participants will be able to:

• • • Implement a step-by-step “best practice” review process for addressing health concerns in a consistent, effective, and constructive manner.
    • Utilize carefully developed talking points and a script when meeting with a colleague to discuss a suspected Health Issue.
    • Establish separate Confidential Health Files and develop a Summary Health Report to be utilized at reappointment for colleagues who are experiencing a Health Issue.

PART 4:

Session 7:  Step-By-Step Processes for OPPE and FPPE to Confirm the Competence and Professionalism of New Members

Upon completion, participants will be able to:

• • • Implement a step-by-step “best practice” process for conducting OPPE activities in a consistent, effective, and constructive manner.
    • Implement a step-by-step “best practice” process for conducting focused reviews of new Medical Staff members in a consistent, effective, and constructive manner.
    • Utilize standardized forms to guide and document retrospective case reviews, 360 evaluations, and direct proctoring.

Session 8:  Step-by-Step Process for Addressing Medical Necessity and Utilization Issues as Core Components of Your PPE Process

Upon completion, participants will be able to:

• • • Describe the three related, but different, types of utilization issues that need to be addressed as part of a Medical Staff’s peer review process.
    • Implement a step-by-step “best practice” review process for addressing utilization concerns in a consistent, effective, and constructive manner.
    • Modernize the role and function of a Utilization Review Committee and ensure that it is contained in the Bylaws as a Medical Staff committee.

PART 5:

Session 9:  Effective Collegial Counseling – How to Be “One and Done!” (And How to Document It, Where the Documentation Is Kept, and Who Has Access to It)

Upon completion, participants will be able to:

• • • Describe the Progressive Steps Continuum and incorporate it in all peer review processes at the hospital, irrespective of whether the performance issue involves clinical, professionalism, health, or utilization concerns.
    • Utilize a carefully developed Checklist when preparing for, conducting, and then documenting Collegial Counseling sessions.
    • Describe the two categories of documentation that are contained in a Practitioner’s Confidential File and develop a Policy that governs access to each.

Session 10:  Voluntary Enhancement Plan Options for Both Clinical and Behavior Issues – That Actually Work!

Upon completion, participants will be able to:

• • • Identify and utilize the most effective Voluntary Enhancement Plans available for successfully addressing clinical concerns.
    • Identify and utilize the most effective Voluntary Enhancement Plans available for successfully addressing behavior concerns.
    • Utilize carefully drafted checklists, template letters, and forms when implementing a VEP with a colleague.

PART 6:

Session 11:  Managing Conflicts of Interest – Pure and Simple, the Traditional Way Doesn’t Work.  Walk into the Light!

Upon completion, participants will be able to:

• • • Identify the most common “conflict of interest” scenarios that arise when performing peer review activities.
    • Utilize a modern tool that effectively educates the Medical Staff and guides the consistent management of conflict of interest issues that arise.
    • Implement consistent rules for recusal when a Medical Staff member has a conflict of interest that prevents the member from participating in a peer review matter.

Pricing

Assemble a team and join us for a fee of $1,095 to cover all six parts/12 sessions and all the supplemental materials.  CME is also available for any practitioner who may desire it for an additional $125 per individual.  (NAMSS credits are provided as part of base fee.)

On-Demand Resource/ Future CME

On-Demand Resource/Future CME

After participating in The Deep Dive series, you may wish to use it as an enduring resource in the coming years to reinforce the best practices learned, train your “new” leaders and reviewers, and ensure that the gains you achieve now remain ingrained in your culture!

As such, The Deep Dive series may also be purchased for use as an On‑Demand Tool that allows you to educate and develop future physician leaders and provide CME activities for your Medical Staff. Here are the details:

• You may access The Deep Dive series as a whole or any of the individual sessions within it (e.g., train your new case reviewers using Session 4 in the series; teach “collegial counseling” techniques using Session 9) for as long as you would like.

• Access is unlimited. Use the series and any of its sessions as often as you may need them and whenever it is convenient to your team members. The sessions are available on any device with an internet connection.

• Every physician who participates in the sessions can obtain Category I CME credits for each session watched — through July 27, 2023! Importantly, there are no additional fees for claiming these CME credits through July 2023, which is an extraordinary benefit.

• Because you purchased the initial The Deep Dive series, this On-Demand Tool is available for a significant discount off the regular price ($3,250 instead of $7,685).