Dr. Skip's Medical Peer Review Blog: Importance Of Having A On Site Clinical Staff in Independent Review Organizations

Thursday, March 08, 2007

Importance Of Having A On Site Clinical Staff in Independent Review Organizations

Many independent review organizations actually work without having any onsite clinical staff within their companies. In fact, they have administrative and operational people who provide the coordination of sending, receiving, proofing, and editing reviews that are done only by outside specialists.

Our own viewpoint is that an IRO today needs to have an internal full time clinical staff working inside the company. There are a number of reasons for this. First, having doctors on staff allows us to provide a much higher level of customer service to our clients than IROs who don't. Second of all, those doctors are needed in order to correctly select the right specialists for each review that comes in. Why is this? Many of these review requests are highly technically and only can be decided upon in terms of where to send cases by a physician. Third, having in house physician staff allows us to interpret and communicate with specialists who are on our peer panel at a much higher level than IROs who do not. Finally, many of our clients ask for us to make telephone calls to attending physicians prior to rendering a final review determination. This is next to impossible to organize between a peer specialist who is in active practice and an attending physician. Therefore, it makes sense for us to have our own medical staff that is capable of doing this in house. Typically, multiple attempts have to be made in order to catch an attending physician when they're not seeing patients. Having your own medical staff is the way you achieve this.

For a number of reasons today's IRO is called upon to have a full time clinical staff to be able to interface at the level that is required in order to meet customer demands. Our own clinical staff consists of primary care and emergency physicians. In addition, they are supplemented with physicians assistants and registered nurses who work for them but can still use their medical knowledge to interpret cases and provide some of the background work required as a part of the independent review process.