Conduct meaningful peer review in ambulatory settings

In the ambulatory arena, top problems include identifying viable reviewers, developing a robust assessment mechanism, and putting aside collegial and business allegiances to ensure meaningful evaluation.

“Peer review is always a bugaboo for organizations—who’s going to do it, what’s it going to consist of,” says Marshall Baker, FACMPE, president and CEO of Physician Advisory Services, Inc., a consulting firm for physician practices in Boise, Idaho, who notes that many underperforming organizations limit the process to a clinical record review. “They need to really drill a little deeper into the entire life practice experience of the clinician for the period of peer review.”

Incorporate an array of metrics that provide a more holistic view of the practitioner’s performance, says Baker, pointing to trending, patient satisfaction metrics, and incident reports as peer review staples. “The approving authority has a better picture of the clinician’s practice pattern, and it becomes genuine peer review.”

Here, the size and circumstances of a facility’s practitioner pool come into play. “You have physicians who are really elbow to elbow; they log numerous times a day or numerous times a month,” says Baker. What’s more, at small group practices, all or most affiliates may have an ownership stake in the company, says Kathy Matzka, CPMSM, CPCS, FMSP, an independent medical staff consultant in Lebanon, Illinois. This combination of close proximity and competing interests can engender reluctance to scrutinize colleagues’ performance, leading to superficial evaluations and free passes for slipups.

To improve practitioners’ engagement in peer review, Matzka recommends developing a standardized process and enforcing its consistent application.

Organizations should also incorporate peer review into their quality improvement programs, Baker advises. This means scheduling a deep-dive evaluation of the current process every 1–2 years to assess organizationwide performance against key benchmarks, leverage strengths, and transform weaknesses into improvement plans.

Source: News & Analysis