JCAHO Standards Expand External Peer Review Use by Hospitals
April 3, 2007 - The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for 2007 broadened the need for hospitals to use external peer review, according to Dr. Skip Freedman, chief medical director at AllMed Healthcare Management, an independent review organization (IRO). Peer review is an internal process by which hospitals assure that its doctors are competent and well trained enough to safely treat patients and provide the best quality care. Hospitals turn to unbiased third parties, like IROs to augment evaluations of cases involving doctor errors, or when internal conflicts of interest exist precluding an objective evaluation.
For 2007, the JCAHO defines two types of reviews aimed at assuring physician competence, “focused professional practice evaluation” (MS.4.30) and “ongoing professional practice evaluation” (MS.4.40). “Both standards broaden the idea of peer review to areas beyond the peer review committee and accordingly extend the use of external peer review too,” he said.
MS.4.30 covers credentialing, proctoring and provisional monitoring of doctors for whom a hospital lacks documented evidence of competence for performing a privilege. It also covers doctors asking to perform new procedures. MS.4.40 stresses continual hospital evaluation of a physician’s performance to identify any practice trends affecting patient safety or quality care. Freedman said that because hospitals have internal politics, aggressive economic goals, and the need to continually improve their quality of care and patient safety, they will turn to external third-party review to provide the objective, evidence-based opinions they need to meet these areas of the JCAHO standards in a timely manner.
Under the new standards, hospitals must demonstrate they are making decisions about doctors that are based on objectivity and not personal bias or rivalries. The new standards demand “objective, evidence-based” evaluations that impartial third parties can provide, and hospitals of all sizes will need external help to assure compliance. “Small and mid-sized hospitals conforming with these standards may need help conducting proctoring evaluations and ongoing reviews of doctors, because they’re often shorthanded in a particular medical specialty or their doctors have relationships outside the hospital that hinder objectivity,” he said. “But larger hospitals and even hospital groups can also lack the right unbiased specialist peer for proctoring or reviews, or they may want an external review of a doctor’s performance data to discover any negative trend.”
“The good news about the new JCAHO standards affecting peer review is they emphasize processes that filter out the worst doctors by scrutinizing them and insist doctors current on their skills to keep privileges to create greater safety for patients,” said Freedman. “As the standards are adopted, as an IRO, we’re hoping we will be reviewing fewer physician operating room mistakes, because the standards strongly support ongoing training and upgrading of a doctor’s skills. Instead we expecting to see more corrective external peer reviews rather than ones coming out of a peer review committee that needs objective validation for disciplinary, or even, legal action.”
More information on AllMed’s External Peer Review services can be found on AllMed’s web site at http://www.allmedmd.com.
About AllMed Healthcare Management
Founded in 1995, AllMed (http://www.allmedmd.com/ ) 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.