Applying Six Sigma to Hospital Peer Review

It's time to raise the discussion on how to apply six sigma quality principles to the medical peer review process in hospitals. While many "experts" are touting the value of apply lean six sigma methodologies to health care (see article below), nowhere is there more opportunity for improvement in hospital performance improvement and patient safety than in peer review. While some hospital groups have a repeatable peer review process that consistently and objectively measures practitioner performance, we talk to medical staff and peer review committee members every day who indicate the need for a holistic overhaul at their hospitals.

To achieve this, hospital leaders should start by studying six sigma principles and initiating a dialogue on how to apply them to their peer review committees. The application of these principles have positively impacted many industries, and which could be easily applied to peer review in order to raise performance, accountability and transparency. --AGR

Lean & Six Sigma: Fixing Healthcare a Process at a Time
By Carolyn Pexton

iSixSigma

With so many different issues facing the U.S. healthcare system the task of “fixing” it can seem insurmountable. Every healthcare executive knows the litany of challenges: rising costs, inadequate insurance coverage, capacity constraints, patient safety concerns, workforce shortages, increased competition, optimization of new technologies, etc. Some industry experts want a complete overhaul of the nation's healthcare system, while others tout information technology as a cure or consumer-directed healthcare as the inevitable wave of the future. Then again, for some people the problems appear so big that genuine, pragmatic and sustainable solutions are hard to envision.http://healthcare.isixsigma.com/library/content/c071121b.asp

Conflict of Interest In Hospitals Under Growing Scrutiny

This article points out the increased scrutiny of physicians' financial conflict of interest in hospital settings, and how it can lead to over-utilization. It also goes on to point out the opposite argument -- that physicians who are stake holders in a hospital's success tend to act in the best interests of both the hospital and patients.

One point that the article fails to mention is how conflict of interest can impact the objective evaluation of practitioner performance within the context of the hospital peer review process. We hear many medical staff members point to peer review committees that fail to properly scrutinize the performance of fellow practitioners, as a result of financial ties. On the other hand, we are also aware of sham peer review carried out due to economic rivalries.

Whichever situation you have experienced, the fact is that peer review inside the hospital is fraught with potential conflicts of interest, that can be easily identified and eliminated. The key is having the right combination of leadership, by-laws, policies and procedures and a clear commitment to using external peer review when necessary. IROs (independent review organizations) have a clear role to play in eliminating conflicts and improving hospital quality. --AGR

Featured Story January 18, 2008

Physician Financial Relationships, Conflicts of Interest Are Expected to Top List of 2008 Enforcement Targets

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

While some familiar areas are among probable 2008 targets of enforcement agencies, expect the focus to broaden, say experts. So while areas such as hospital-physician relationships will continue to garner scrutiny from the HHS Office of the Inspector General (OIG) and the Department of Justice (DOJ), whistle-blowers and health fraud investigators may also turn their attention to areas such as admission necessity, behavioral health and evaluation and management (E/M) coding.

Lawyers expect physician financial relationships to be at the top of the enforcement list. "The intense scrutiny on physician financial relationships and conflicts of interest will continue unabated in 2008," says former senior OIG attorney Howard Young. "The medical device industry may face the brightest spotlight with ongoing criminal and civil anti-kickback investigations continuing into surgeon consulting and other arrangements. And more so than in past years, this may be the year in which DOJ and OIG pursue enforcement actions against physicians who receive the alleged industry kickbacks."