|
Quality Management >
Services >
Consultants
>
Publications >
 Quality
Management Services: General Peer Review Process
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.
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.
|