Ask the expert: What are rate, rule, and review indicators?

The Greeley Company has developed a way to describe physician performance measurement tools that reduces the time physicians spend on chart review while still providing accurate information on physician performance. It shifts the peer review process away from reviewing individual cases to reviewing more aggregate data. This method divides physician performance indicators into three categories:

• Review indicators: This type of indicator identifies a significant event that would ordinarily require analysis by physician peers to determine cause, effect, and severity. It is otherwise known as traditional chart review. The medical staff office should maintain documentation in a file for immediate action or for future reference as necessary.
• Rule indicators: This type of indicator represents a general rule, standard, generally recognized professional guideline, or accepted practice of medicine where individual variation does not directly cause adverse patient outcomes. Rare or isolated deviations usually represent only a minor problem. If a rule event occurs, support personnel sends a report of findings to the physician and a copy is maintained in a medical staff file for reference. If the hospital identifies a pattern of rules or a potentially serious isolated event, it reports this information to the medical staff quality improvement committee and to the appropriate department chairperson and the chief of staff.
• Rate indicators: This type of indicator identifies cases or events that are aggregated for statistical analysis prior to review by the appropriate committee or administrative function. It may be expressed as a percentage, average, percentile rank, or ratio. A target range should be established for each indicator based on best practices from benchmark data, statistical variation from the average, or internal targets. The hospital provides physicians with rate feedback on a regular and timely basis. If a physician falls outside the target range, the appropriate leadership determines what, if any, action should be taken.

To learn more about rate, rule, and review indicators, see Effective Peer Review: A Practical Guide to Contemporary Design, Second Edition by Robert J. Marder, MD; Mark A. Smith, MD, MBA, FACS; and Richard A. Sheff, MD.