Tip: Know the OPPE rules for employed physicians
Q: Are employed physicians who have been granted privileges subject to the organized medical staff’s clinical case review portion of the ongoing professional practice evaluation (OPPE) policy and all its attendant protections?
A: The answer is both yes and no. How can that be?
The “yes” answer is that the employed physician is subject to the same standards of care and evaluation of that care as any other physician. Most physicians understand the clinical care/case review process to be the traditional idea of peer review. This process is almost invariably organized at the level of the organized medical staff within the hospital. The process for employed physicians with privileges can be the same because they are working with the same community of patients who are receiving care in the hospital. They are subject to the medical staff’s accountability to the governing board to ensure quality care, which is primarily dependent on individuals granted privileges. The hospital employer is probably not well suited to review physician clinical care issues. In fact, it rarely makes sense to create a separate process for employed physicians to accomplish clinical case review (with the possible exception of a very large and sophisticated hospital-employed multi-specialty practice that has the capability and ability to perform effective peer review on its own). Alternatively, a separate process for the evaluation of ambulatory care might be useful to supplement the inpatient medical staff directed process. But even then, why duplicate a process if the one that already exists can be tightly integrated to meet everyone’s needs while still preserving the protections that your state may give to peer review activity?
The “no” answer requires some explanation. In general, the medical staff peer review process is marked by the strictest of confidentiality in order to preserve whatever protections are afforded by state statutes. Peer review committee members are advised to never discuss anything outside the meeting, and minutes/notes are religiously collected at the end of the meeting to avoid any inadvertent distribution. But the health system employer bears all of the liability for the actions of its employees, including physicians. It has a legitimate interest in knowing whether clinical concerns exist. Therefore, to bridge this gap, many health systems will develop methods of information sharing between the medical staff peer review process and the health system employer. For that reason, the “no” means that the employed physician’s peer review information may be readily available to his or her employer. In the case of a non-employed physician, such health system–based peer review information would never be shared with the physician’s employer. Note, however, that some large non-employed medical group practices may have a similar peer review information sharing agreement with the health system—that is, one that would allow sharing of such information for very similar reasons, as the medical group bears the liability for its employed physicians.