Medical peer review

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Medical peer review

Medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met accepted standards of care in rendering medical services. Depending on the specific institution, a medical peer review may be initiated at the request of a patient, a physician, or an insurance carrier. The term "peer review" is sometimes used synonymously with performance appraisal.

The medical peer review committee

The objective of a medical peer review committee is to investigate the medical care rendered in order to determine whether accepted standards of care have been met. The professional or personal conduct of a physician or other healthcare professional may also be investigated. If a medical peer review committee finds that a physician has departed from accepted standards, it may recommend limiting or terminating the physician's privileges at an institution. Remedial measures including education may also be recommended.

In hospitals, only a peer review committee authorized by the physician medical staff is authorized to take action regarding a physician's medical privileges at that institution.

A committee convened by the hospital administration or other group within the hospital may make disciplinary recommendations to the physician medical staff.

Departmental peer review committees are comprised of physicians, while hospital-based performance-appraisal and systems-analysis committees may include nurses or administrators with or without the participation of physicians.

Medical boards as peer review committees

State medical boards conduct peer review of licentiates. In some states, boards are composed of physicians; in other states, the medical board may include attorneys and other non-physicians. Physicians are part of the board in primarily advisory capacities. Under this structure, the medical board asks for a medical peer review by a committee of physicians that may or may not be part of the panel of physicians serving as advisors to the board.

Other state boards are run primarily by physicians from that state. In these states, peer review committees may be made up of members of the board solely, or by a committee selected from a panel of physicians not affiliated with the board. Decisions regarding physician licensure are recommended by the medical peer review committee to the board, which rejects or accepts the committee's recommendations.

Medical peer review:Abuse

Controversy exists over whether medical peer review has been used as a competitive weapon in turf wars among physicians, hospitals, HMOs, and other entities. Abuse is referred to as "sham peer review" by those who consider it endemic, and they allege that the creation of the National Practitioner Data Bank under the 1986 HCQIA facilitates such abuse, creating a 'third-rail' or a 'first-strike' mentality instead of an attempt to protect patients.

Defenders of the Health Care Quality Improvement Act state that the National Practitioner Data Bank protects patients by helping preventing errant physicians who have lost their privileges in one state from traveling to practice in another state.