QUESTION: We’ve taken steps in the last year to change the perception of peer review from punitive to educational. We’ve eliminated scoring, increased the use of educational sessions to share lessons learned from the review process, and created accountability for fixing system/process concerns that are identified during the review process. Overall, our physicians feel the process is much improved. However, there are occasional holdouts who refuse to provide input when their cases are under review, and who seem intent on simply delaying the review process. What can we do?
ANSWER: Obtaining timely and meaningful input from the physician under review is an essential element of an effective and fair professional practice evaluation (“PPE”) process. Giving the physician an opportunity to provide input enhances the credibility of the process and encourages everyone involved to think critically about a case.
There are several fundamental rules to obtaining input. Most importantly, PPE policies should state that no “intervention” (such as an educational letter or a performance improvement plan) will occur until a physician has been given the opportunity to provide input. Also, physicians should be given the opportunity to provide both written and verbal input by meeting with those conducting a review. Input can be obtained at any point in the process, and multiple requests for input may be made.
If a reviewer has questions about a case, the physician should be notified of the concerns. Any letter to the physician must be carefully drafted to avoid giving the impression that a decision about the case has already been made.
The PPE policy should also make clear that a physician cannot stop the review process by not providing input. PPE policies should state that individuals who fail to provide input when requested by the PPEC can be deemed to have temporarily and voluntarily relinquished their clinical privileges until the input is provided. Such relinquishments do not entitle the physician to a Medical Staff hearing or appeal, nor are they reportable to any federal or state government agency. Instead, they are merely an administrative “time-out” until the physician provides the requested information.
To learn more about PPE best practices, join Paul Verardi and Phil Zarone by dialing in for the upcoming audio conference: Professional Practice Evaluation Policy — Special Topics on July 11.