"Peer" Review Policy Isn't

Is it too much to ask that peer review involve peers? So-called “Peer” Review Policies are being ginned out by hospitals, ostensibly to meet recent Joint Commission standards, but under which peers (those actually treating patients based on their post-college degrees and training) have nothing to do with the review except to apply a rubber stamp at the end. Don’t let accreditation be an excuse to take the peer out of peer review.

A typical cookie-cutter “peer” review policy has the hospital’s quality improvement staff feeding whatever information it feels warrants attention (or which the hospital needs to knock off an unprofitable service line or an outspoken physician) to the quality improvement committee, which, even if it is delineated in the medical staff bylaws, is comprised by no small number of administrative personnel. Surprise! The unprofitable or unglamorous service does not pass the package’s muster. The independent practitioners of a lucrative service are replaced by hired hands. The basis for such convenient decisions? Pre-packaged data sets purchased from the financial officer’s favorite pro-hospital consulting firm, or marketing survey/patient satisfaction “data” being used as if it were, well, data.

Reality check, please! Unfiltered patient satisfaction survey outcomes used as specific measures of individual physicians, where the sick patient being surveyed may not remember whether that scrub-clad person is a neurosurgeon or a transport tech, or may be focusing more on the quality of the applesauce than on the sophistication of the diagnosis, cannot safely determine who should provide care. Those pre-printed “customized” quality measures that no one on the medical staff has ever seen, much less promulgated, are not going to improve quality on the ground or even be worth the exorbitant consultant’s fee, if there is no acceptance by the medical staff because the measures are unrelated to real clinical issues. Phony peer review isn’t worth the trouble, much less the price----assuming quality care really is the goal.

Medical staff bylaws should establish that peer review actually means review of peers by peers, done right, and for the right reasons. Done right means that clinical criteria are determined by clinicians on the medical staff, and the data sets are determined by medical staff departments, consistent with Joint Commission standard MS 4.40. Done right also means that state law requirements are followed to the letter and state-specific qualified protections are earned, which national consultants’ policy kits frequently overlook. Done for the right reasons means that instead of scalp-hunting, peer review results in improved quality, either by educating or assisting someone missing the standard the medical staff sets, or by correcting problems in the systems that fail to result in good care. Well-drafted medical staff bylaws prevent the use of peer review as punishment, and provide for the transparency needed to avert abuses, thus creating a medical staff in which members are comfortable bringing forward and solving real problems. No “peer” review policy needed.

© 2009 Elizabeth A. Snelson, Esq.
Questions? Comments? easesq@snelsonlaw.com
Click icon below to email this article to a colleague.