Ask the expert: Should physicians be paid to perform peer reviews?

Unfortunately, there is no right or wrong answer to this question. No physician will ever get rich from serving on a peer review committee. However, physicians are facing increasing economic pressure to maintain high levels of productivity in their office practices. In addition, many desire lifestyles that are less committed to the hospital. Therefore, the loss of income resulting from voluntary participation in peer review has affected many medical staffs.

The answer to this question is based on a number of factors, including to what degree your medical staff culture will even allow physicians to be paid for administrative tasks. 

Asking yourself the following four questions may help you make the right decision for your hospital:

• Should you pay? There is nothing illegal about paying physicians to perform peer reviews so long as you are paying them a reasonable amount. The real issue is what your medical staff members think about physicians getting paid. If your medical staff would react negatively, you either need to change the culture, or abandon the issue.
• Who should get paid? Most medical staffs focus on those who go above and beyond rather than on those who simply show up for meetings. Attending committee meetings is part of physicians’ citizenship responsibilities. If you can define what “going above and beyond” means, you can develop a fair compensation mechanism.
• Who should pay? Typically, the hospital will be the source of compensation. Sometimes the hospital provides the medical staff with a lump sum to pay physicians for various activities and leaves it up to the medical staff to distribute it. In other cases, the medical staff provides some or all of the funds from the medical staff dues.
• How much should you pay? The legal issue here is based on the Stark law for inurnment. You need to establish an administrative hourly rate for physicians and apply it equally to all physicians, regardless of specialty. Usually, this rate is in the range of $75 to $150 per hour. Then you need to establish a method to quantify the actual work being performed. You can either require the physician to track his or her actual time for reviewing cases or establish general per-case compensation.

The preceding information is an excerpt from Effective Peer Review: A Practical Guide to Contemporary Design, Second Edition, by Robert Marder, MD; Mark Smith, MD, MBA, FACS; and Richard Sheff, MD.