QUESTION:
Our team just attended your seminars in Amelia Island.  The one member who attended the Peer Review Clinic came out of the session with a strong belief we should remove “scoring” from our case review forms.  He’s had some trouble convincing the rest of us, so we wanted to hear it right from the horse’s mouth – why do you recommend against scoring cases?

ANSWER FROM HORTYSPRINGER ATTORNEY IAN DONALDSON:
We are happy to back up your colleague on this one!  The reasons we recommend moving away from using scoring as a part of the peer review process are based on the following issues:

• We have observed that peer review committees spend a lot of energy on assigning the score, which distracts from the more important issues of whether there is a concern with the care provided and, if so, the appropriate intervention.

• While scoring gives a perception of being objective, we’ve found that numerical scores don’t necessarily capture the complexity of a case in the same way as a detailed description from a case reviewer.

• We have found that reviewers may be uncomfortable assigning low scores, which often carry labels indicating that the physician’s care was “inappropriate” or “below the standard.” As a result, the reviewers choose higher scores indicating “care appropriate” even if there are concerns.

• Negative 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.

If you have a quick question about this, e-mail Ian Donaldson at idonaldson@hortyspringer.com.

Please join Ian Donaldson and Charlie Chulack at an upcoming Peer Review Clinic to learn more about the new approaches Medical Staffs are taking to traditional peer review matters. You can learn more by clicking here.