Choosing the Right Peer Review Partner

Problem:

“We have decided that we need external peer review for a number of cases. We have not used external peer review before and are not certain as to how to evaluate the available options.”

Solution:

This was exactly the challenge the founders of MDReview faced, which led to our creation of MDReview. On several occasions, we identified our need for an objective external peer assessment. But given the limited number of satisfactory options available, we came to dread the process. And as we came to terms with how serious the ramifications of peer review could be, our anxiety grew. Would the review be completed in our timeline? Would it be well written, clear and concise? Would the report provide clear conclusions that were well supported? Would the physician reviewer be credible? What would happen if we spent a great deal of time, effort and money for the review and received an inferior report? Given hourly billing, what would the peer review cost? Would the physician reviewer provide us with ongoing support should we have follow-up questions or need involvement in fair hearing?

As the number of external peer review providers has grown, so has the challenge of differentiating one from the next. Given the similarities in terminology and promotional language, it would appear that the various firms approach peer review similarly. However, peer review firms vary widely in the way they conduct peer review. Some of the differences are dramatic. For example, some firms involve non-physicians to write an abstract from the medical record and it is that abstract that is reviewed by the physician reviewer. Some firms require that you enter into a 30 page agreement while others require no agreement at all. Some charge $2,500 while others charge $500 to review the very same case. The differences among firms are stark and compelling.

At the same time, healthcare organizations vary in what attributes they demand of a peer review firm. Some have given little thought to either the options or the implications of their selection. There are choices and the choice your organization makes is critical. It can mean the difference between a high-integrity, respectable process, and one that is indefensible and diminishes trust. I suggest close scrutiny of any prospective external peer review partner. As you seek a partner that supports your organization’s culture and approach to peer review, consider getting answers to the following questions from all prospective firms:

1. How do you ensure that your physician reviewers are credible? Do they have the appropriate qualifications? Are they actively practicing and Board Certified? Are they carefully matched to the specifics of each case? Will we have a say in which reviewer is used for each project?
2. Do you train your reviewers to conduct peer review? How?
3. Do you monitor the work of each reviewer? How do you make sure your reviewers adhere to the highest standards?
4. What is your track record with respect to timeliness? Do you meet your deadlines?
5. Do you have a consistent report format that never fails to provide clear, concise conclusions?
6. Can you assure us that your reviewers will be available for subsequent proceedings after the review? Will they address follow-up questions? Are additional fees involved?
7. Will we know the cost of each engagement up front or not until the invoice arrives?
8. Do you assign a project management team to each project to ensure that the work is done to standards?
9. Are the reports proofread before being finalized? By whom?
10. What kind of agreement do you require that we execute to be able to access your services?
11. What steps do you take to make sure each review is objective, fair and balanced?
12. How easy is your firm to use?
13. Does your firm have strong references that reflect an outstanding track record?
14. What is the level and type of experience of your firm’s leadership? How is this experience relevant to physician peer review?
15. Given the wide variety in fees, are yours competitive? How are your fees set? What are we getting for our money?
16. Is your company as serious as we are about preserving confidentiality?
17. What is your process for conducting the review?

All peer review is not conducted in the same fashion. In fact, there is tremendous variability. The approach used can directly affect the integrity of your process, favorably or adversely. The implications are simply too important to allow the selection of an external peer review partner to be taken lightly.