IROs and the Hospital Peer Review Process
By AllMed Healthcare Management
Many hospital CEOs, medical directors and risk managers are hesitant to consider outsourcing peer reviews, because they simply have never done so in the past. They have concerns about invasive scrutiny by external organizations, potential loss of control, the possible polarizing effect on their staff and a fear that the focus will be on finding and punishing "bad doctors.
Because of inherent conflicts of interest that exist in hospitals peer review process, hospital quality management systems need to ensure objectivity and adherence to accepted medical protocols.
For this reason, many hospital groups are proactively moving toward Independent Review Organizations for unbiased peer reviews. Not only are they seeing this as a best practice, but they also gain other benefits, including rapid resolution of sensitive cases, heading off high-profile lawsuits, reducing internal polarization and preventing damage to physician's careers.
Done correctly, peer review takes a systematic approach to determining the reasons for sentinel events that have undesirable outcomes. The focus is not on "good doctor or bad doctor issues, but on a broader range of questions such as:
Was there adequate support?
Were the protocols and processes defined?
Do we have the right physician expertise and training to consistently produce positive patient outcomes?
Do we need better trained assistance?
The true goal of the peer review process is not to point fingers or punish people, but to improve patient safety by identifying quality management issues and fixing them.
Download our free white paper "Best Practices in Hospital Peer Review" (http://www.allmedmd.com/resources/downloads/wp_bppr.htm).
About The Author
AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com, https://allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.