New Standards Increase Conflict of Interest Concern
The Joint Commission’s new standards produce an unintended side effect: They heighten conflict-of-interest issues because they increase the number and intensity of physician evaluations that are required to meet the intent of the standard.
As hospitals’ credentialing and privileging of physicians requires more in-depth peer reviews, medical staff executives and internal peer-review committees must be on the lookout for conflict-of-interest situations during both focused and ongoing physician evaluations. Ignoring them opens the door for “conflicted” reviews − that is, specialist practitioners who inadvertently review another doctor with whom they have a social or working relationship. They might even be in competition with one another over patients. These kinds of reviews can decrease the quality of care and patient safety.
Hospitals that want to meet the quality-of-care guidelines, insure objectivity and protect their patients must have physicians review only “like specialists.” That is, cardiologists should review cardiologists with whom they have no connections. This process is needed for every specialty.
Demographics increase the chance a reviewer will have a professional, social or personal connection with other peer specialists that may taint the objectivity of a peer review. The size of the hospital group and the size of its community are factors in finding “like specialists” without conflicts. For smaller hospital groups in smaller communities, it is probable that any “like specialist” will have a conflict of interest.
Hospitals should educate medical staff and peer review committees about all potential conflicts of interest as they relate to peer review. They must understand the web of economic, competitive and personal relationships that can raise concerns about a completed review.
Whenever a reviewer is in partnership, competes for patients or socializes with the reviewed physician, the conflict-of-interest question should be raised. Ideally, a reviewer will alert the peer-review-committee chair when a conflict exists and request another reviewer. If a suitable reviewer is not available, the committee chair should consider an external peer review.
Once a hospital establishes transparent standards for managing conflict of interest and understands the interconnections of its medical staffs’ relationships, it can manage them. With this knowledge, a hospital then can randomly select several cases from all practitioners to meet the ongoing evaluation requirement.
Already, we are seeing hospitals using rotating schedules for ongoing evaluations of their medical staff several times a year with independent review organizations, to eliminate conflict-of-interest concerns about their reviews. Using this process, the hospital can validate the competence of every practitioner to perform specific privileges once conflicts are eliminated.