Professional Practice Evaluation Committee

September 16, 2021

Posted on by Courtney Patterson

QUESTION:
We’re developing new case review forms for our peer review process and wondered whether we should ask reviewers to assign a numerical score to various aspects of care.  Do you recommend scoring cases in this way?

ANSWER:

No!  In our experience, scoring has the following drawbacks:

(1)        Too much energy is spent assigning the score, which distracts from the most important questions:  Is there a concern with the care provided, and if so, how can that concern be addressed?

(2)        Numerical scores can’t capture the complexity of a case in the same way as a longer narrative.

(3)        Physician reviewers may be uncomfortable assigning low scores which indicate that care was “inappropriate” or “below the standard,” especially if those scores are accompanied only by short statements such as “care below the standard.”  As a result, they choose higher scores indicated “care appropriate” even if there are concerns.

(4)        Scores may put physicians on the defensive, especially since most scoring systems don’t allow for the provision of nuanced information.

These characteristics of scoring can undermine efforts to make the peer review process educational rather than punitive.  Accordingly, we recommend having a peer review/professional practice evaluation (“PPE”) system that focuses on actions and performance improvements rather than scoring.

April 18, 2019

Posted on by hortyspringer

QUESTION:        Our Professional Practice Evaluation Committee recently asked a physician to attend one of its meetings to discuss several of his cases that are under review.  The physician says he’ll only attend if his attorney is with him.  Do we have to allow the attorney to attend?

ANSWER:            No.  The best way to address quality or behavioral concerns is for physicians to speak with physicians in a collegial and professional manner.  The presence of an attorney would likely cause committee members to speak less candidly and be concerned that their comments – no matter how accurate and honest – would be viewed as hostile or “defamatory.”  Also, an attorney might try to raise procedural arguments that distract from the substantive concerns being evaluated.

Physicians who are subject to a review are welcome and encouraged to consult with an attorney prior to the meeting if they wish.  They may also ask the attorney to accompany them to the hospital.  However, the attorney should be required to remain outside the meeting room.

We recommend that applicable policies clearly state that no attorneys (neither the hospital’s nor the physicians’) will attend meetings between the physician under review and the reviewing committee (or individuals).  At most, the policies could state that a physician may bring a colleague to such a meeting (such as a partner).  However, in such case, the guest should not be permitted to speak for the physician and should be required to sign a confidentiality agreement.