Question:

Like most hospitals, we’re employing more and more physicians.  We’ve been struggling with how to conduct peer review of these employed physicians.  Should we use the Medical Staff peer review process, or should we address concerns via the employment contract using the Human Resources process?

Answer:

Many hospitals are struggling with this question.  Ideally, the Medical Staff and HR processes can be integrated to take advantage of the unique advantages of each.  It would be impossible to address this question fully in this limited space, but here are some general thoughts.

We recommend that once a concern about an employed physician is logged in to the hospital’s central repository (you do have a central repository, right?), the person or entity responsible for employment decisions be notified.  This may be a hospital-affiliated physician group, or it may be the HR department within the hospital.  (We’ll refer to this person or entity as the “employer.”)

The content of this notification has to take into account the state’s peer review law.  Some states permit the free flow of information among peer review entities, while other state laws do not address this topic.  Where it is not clear that state law permits the sharing of peer review information, one option is for the employer to be notified that a concern has been raised without providing copies of documentation.

Once the employer has been notified that a concern exists, it can choose to review the matter itself or it can ask that the matter be reviewed via the Medical Staff process.  Presumably, employers will be more likely to deal with behavioral concerns on their own, while they may be more likely to defer to the Medical Staff process to review clinical issues.

If the employer does review the matter on its own, it must notify the Medical Staff process of its resolution of an issue.  Importantly, if those responsible for the Medical Staff process are unhappy with the employer’s resolution of a concern, they have the authority to review the matter independently via the Medical Staff process.

If the employer asks the Medical Staff to review an issue, the employer can be kept in the loop by having the person responsible for employment decisions (or a designee) take part in the Medical Staff’s review of the issue (this may be the VPMA or the physician in charge of the hospital-affiliated group).  This is perhaps the safest approach to protect the peer review privilege, depending on state law.  If at any point during this process the employer concludes that the physician’s employment should be terminated, the employer may do so (subject to the procedures set forth in the employment contract).

There are numerous other factors that must be considered, such as whether the physician’s contract has an “incident and coterminous” provision, whether it has a “no cause” termination provision, whether litigation is likely if a physician is terminated, and so on.  But the key point is that it is possible to integrate and coordinate the Medical Staff and HR processes.

For more information on these issues, please join us in Chicago on April 12-14 for The Peer Review Clinic.  Mornings will be devoted to discussions of how hospitals can design a more effective peer review process, while afternoons are free to let you explore all the museums, parks and other attractions of Chicago.