Why M&M conferences are not peer review

As approaches to peer review evolve, it is common for medical staff leaders to confuse the methods for understanding how to improve patient care overall with the processes used to evaluate individual physician performance. Both are important and are often interrelated as they evaluate very similar things. Nevertheless, it is critical to recognize the difference between these processes and ensure they maintain their official separate functions. Doing so will ensure that the peer review process consistently and fairly evaluates each individual physician.
Mortality and morbidity (M&M) conferences are one patient care improvement mechanism often confused with the formal peer review process. Peer review committee meetings are not the same as M&M conferences even though some hospitals have combined the two in the past. Combining them may be a practice left over from when M&M conferences did satisfy The Joint Commission and state regulatory requirements for physician peer review.

Today, however, M&M conferences should serve a solely educational function; in fact, most physicians were first introduced to M&M conferences in a formal educational context during their residency or medical school training. As an educational forum, M&M conferences are collegial open discussions of clinical cases or situations. These discussions involve groups of physicians and other healthcare professionals who have an interest in the clinical case. Although M&M conferences focus on individual cases, as do physician peer reviews of individual cases, they may or may not include an evaluation of a particular physician’s performance. If M&M conferences do include an evaluation of the physician’s performance, it should only be a general one. Anything more than that in the M&M setting would be unfair to the individual physicians and would have a seriously negative effect on the collegial and educational atmosphere.

Another difference between the two is that M&M conferences are not confidential and may not be protected from discovery, and peer review is. Ensure that medical staff do not confuse M&M conferences with the peer review process by making it clear that M&M conferences are a continuing medical education function of the medical staff.

Despite these differences, note that there can be a connection between the peer review process and the M&M conference, particularly within the context of residency programs. In academic medical centers, for example, residents can identify cases presented in an M&M conference that should be referred to the official peer review process, thus precluding the need for nurse reviewers or other quality analysts to perform the preliminary screening function.

M&M conferences are an important tool of improving patient care, but they are not a good substitute for a well-structured peer review program.

Robert Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.