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QM Services: General Peer Review Process
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This service supports focused and ongoing practitioner performance evaluation processes of peer review activity, to include licensed independent practitioners and allied health practitioners privileged by the medical staff. Our consulting practitioners are actively practicing physicians and allied heath practitioners who believe in the objective process. Timing options include: regular; accelerated; and expedited. Regular timed peer review is utilized for retrospective review of usual fall-out cases. Most regularly timed peer review is accomplished offsite. All peer review reports are supported for medical staff based activities up to and including the fair hearing process. QMCG will explore your needs and provide a no cost or obligation proposal for services. References are readily provided.
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Phase I
Reviewer Selection and Scheduling
QMCG will retain with the approval of the Client, the
services of a Practitioner Reviewer with appropriate certification and organizational medical
practice experience who is not an economic competitor and has no bias or conflict of
interest with the practitioner to be reviewed. An onsite or offsite review initiation date
will be established and, where indicated, application made for appointment to the Medical
Staff of the Client for consulting peer review privileges only. QMCG can
strategize on the most appropriate forum to involve the practitioner
undergoing peer review in the process.
Phase II
Study Design
The focused review study will be designed to include
medical records of concern identified by the Client’s internal processes as well as
any additional records representative of the practitioner’s practice which fall out
using the Client’s quality assessment criteria. An absolute random selection of
medical records for practice representation can also be performed. The proposal is based
on review of cases to be screened by professionals using QMCG criteria with subsequent
review of records by the QMCG Reviewing Practitioner. For onsite peer review, review of
medical records will first be accomplished. The direct practice review will then be
structured based on findings of the medical record reviews. Criteria
can be pre-screened for appropriateness and the Standards of Care
Determinations can be formatted for language continuity.
Phase III
Peer Review
The selected Practitioner Reviewer will
objectively review and evaluate each
medical record offsite based on the documentation in the record against the
applicable criteria.
Phase IV
Report Development
Following the offsite record review, results will be
analyzed to identify trends, categorize concerns and develop conclusions. A detailed
written report will be prepared to include specific reasons supporting conclusions reached
and suggested approaches to corrective action, i.e., proctoring, retraining, etc. The
written report will be express mailed to the appropriate Client contact and a summary
conference call scheduled. Trending over time will be initiated with all ongoing peer
reviews. Deadline dates will be established once all documents are
received after contract initiation.
Practice Evaluation By Direct Observation
(Optional)
Following the offsite medical record review, a QMCG
Consultant and the Practitioner Reviewer will set-up an onsite practice review
schedule. The peer review practitioner will observe inpatient or ambulatory care being
rendered over a 1-5 day period as needed. The QMCG consultant will conduct one-on-one interviews
with the Practitioner's peers, support staff and administration to evaluate practice
subtleties. These interviews will focus on practice, communication and interaction
concerns.
Phase V
Summary Conference(Optional)
If requested, QMCG and the Reviewing Practitioner will
present and discuss the findings and review conclusions in a conference call or onsite
conference with the appropriate individuals. Onsite reviews may conclude with a 1-2 hour
summary conference with a select group of participants.
Phase VI
Follow-Up Activities(Optional)
Actions taken as a result of the external review may result
in a need for further support, i.e., testifying at a fair hearing, assisting in the design
of a retraining program if appropriate, etc. QMCG and the Reviewing Practitioner agree to
participate in such follow-up activities, if requested.
Time Frames
QMCG and its Reviewing Practitioners recognize the
importance of timely review and report submission and commit to conscientiously assure a
thorough, yet expeditious process. The scope and sometimes evolving complexity of each
review dictate the time frames required. On average, Phase I should take no longer than
1-4 weeks, and Phases II through V an average of 8-12 additional weeks based on
twenty-five (25) records, for a total review
time of 9-16 weeks. Onsite reviews can generally be completed within the same time frame
as long as onsite logistics scheduling is efficient.
On occasion, the Reviewing Practitioner and QMCG may
identify a potential need for immediate corrective action in the midst of a review. In
that circumstance, the Client will be notified and time frames will be reestablished to
facilitate the Client's need to respond in accordance with its Bylaws.
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