QUESTION:
We use informational letters as a part of our peer review process.  Is it necessary for us to solicit physician input or feedback before issuing an informational letter?

ANSWER FROM HORTYSPRINGER ATTORNEY CHARLIE CHULACK:
The short answer is “no.”  But first, a little context on informational letters (which can also be referred to as “awareness letters”) – these are a tool in the progressive steps continuum that are designed to address minor performance issues and intended to make practitioners aware of expectations or requirements in, for example, the Medical Staff Rules and Regulations.  Much like the other tools you have in the progressive steps continuum, informational letters are non‑punitive and educational, and they aim to get practitioners to self‑correct using feedback.  Informational letters are triggered when a practitioner does not comply with an objective requirement for the Medical Staff.

Ideally, your multi‑specialty peer review committee should approve in advance a list of objective occurrences for when an informational letter will be sent.  By way of example, most Medical Staffs have requirements in the Rules and Regulations that patients have to be seen by the attending physician daily with a progress note recorded describing the visit.  This requirement could be reflected in your peer review policy or manual as a performance issue that triggers an informational letter.  The key here is that the informational letter is triggered by an “objective” occurrence.  Therefore, whether someone did or did not do something that triggers an information letter should be clear on its face and, because of this, there is usually no need to solicit feedback from the practitioner before issuing the informational letter.  However, if you are addressing an issue and considering an informational letter but have questions for the practitioner about the concern, nothing in your policy should prohibit you from asking those questions.

If you have a quick question about this, e‑mail Charlie Chulack at cchulack@hortyspringer.com