Independent Review Organizations and Credentialing of Specialists

We run across clients who are shifting over to us when their previous Independent Review Organization has amounted to nothing more than a doctor with a small group of his or her buddies who are reviewing charts and providing medical determinations to their clients. That doesn't cut it in today's day and age. An IRO has to have a core competency in recruiting and credentialing top specialists from each specialty area and subspecialty area, as well as allied healthcare fields in order to be at the top of its game.

Our organization has recruited and credentialed well over 300 specialists across the country. AllMed Healthcare is actually one of the smallest. Some IROs have as many as 3 or 4 thousand reviewers. We don't believe that this is effective because unless you're managing huge volumes of independent reviews every day it pays to have fewer specialists doing more reviews so that they can maintain a level of training and involvement with your company. When you over recruit specialists what happens is they never get reviews from you and as a result, they can never remember what the elements of the review processes are and ultimately this leads to a higher level of turnover amongst the specialists.

An IRO needs to be able to recruit and attract the top specialists from their field and this is no trivial task. Neurosurgeons, oncologists, and radiologists (just to name a few), these are doctors who are very highly compensated and extremely busy. Typically, it's very difficult to attract these types of specialists to your company and retain them. An IRO has to be able to exercise both science and art in the process of attracting, retaining, training, and developing these capabilities as a part of it's infrastructure. Recruiting and retaining top specialists is no trivial task for an IRO, and one that adds a lot of value to the process of providing medical reviews for our clients.