Maximizing the Effectiveness of Your External Peer Review Process

External peer review offers an unbiased, evidence-based approach to evaluating a physician’s performance. It is a vital supplement to any effective peer review program in cases where conflicts of interest can arise in internal peer review processes and provides a depth of specialty expertise that some facilities lack.

External peer reviews can be requested by the practitioner under review, the service chief or committee, the Medical Executive Committee, Chief of Staff, or by the Board. The purpose of an external review is to improve the quality of care and provide a proactive approach to risk management for the facility.

There are a number of factors that must be considered in the selection of external peer reviewers:

  • Can use clinical consultants from other healthcare facilities outside of the area but they must have no conflict of interest related to the physician being reviewed
  • Can use an external peer review company to avoid conflicts of interest and bias
  • Reviewers must be like-specialty / practice

The external peer review contract is also extremely important and should delineate the following:

  • Qualifications of the reviewers
  • Scope of the review
  • Confidentiality
  • Indemnification
  • Timeliness of review

External peer reviewers do not need to be granted privileges at the facility, unless the facility’s medical staff bylaws require it or under advice of counsel.

Keys to Maximize the Effectiveness of External Peer Review

There are 8 ways hospitals can maximize the effectiveness of their external peer review program:

  • Case reviews and practitioner follow-up must be timely
  • External peer review should be consistently used to avoid punitive strereotyping
  • Peer review committees should carefully discuss and frame the scope, expectations, and questions to be answered
  • Discuss case scenarios and project requirements with external vendor’s Medical Director
  • Gather all case materials and upload to the vendor’s web portal
  • Review replies with the vendor and clarify questions
  • Provide vendor with feedback on peer reviews
  • Develop continuous improvement programs

To make the external peer review process the most effective, it should be ongoing. An ongoing external peer review program decreases risk, increases the quality of care, facilitates the regular assessment of high-risk specialties, and reduces medical errors, adverse events, and malpractice costs over time.
The use of external peer review to supplement the internal peer review program can increase the effectiveness of a facility’s overall peer review program. In setting up an external peer review process it is vital to choose the right partner, review the contract for areas of importance such as the scope of reviewer qualifications, confidentiality, timeliness, and work to maximize the effectiveness of the program. A quality, effective external peer review program will pay off with decreased risk, increased quality of care, and lower costs of litigation and malpractice in years to come.