External Physician Peer Review: Not Just for the Medical Staff

June 8, 2018 | Posted in Healthcare Consulting

Several years ago, we noticed that some of our clients began to use our external peer review services as a tool to assess medical malpractice claims.  While at first this took us by surprise, we soon came to appreciate how useful our external peer review can be for risk managers, attorneys, and insurers challenged with evaluating exposure.  While the primary use of our external peer review is to address privileging and credentialing matters, the fastest growing area of demand for our services is in the area of claims risk assessment.

This reveals opportunities and new ways of thinking that are often overlooked:

First, it seems that sharing of certain peer review information among quality, risk, medical staff, and business/strategy would support the effectiveness of all disciplines.  A lack of shared knowledge can put patients and the organization at risk.  Though significant barriers that inhibit such sharing exist (peer review protections, confidentiality, internal policies and procedures, etc.), the value of such sharing is compelling and warrants creative solutions.  For example, use of a patient safety organization (PSO) might offer opportunities to overcome many of the concerns associated with sharing peer review information.

Second, short of being able to freely share reports, external peer review resources, like those provided by NorthGauge, can be shared.  Typically, our relationship is exclusively with medical staff, quality, or risk management.  But given its potential, we don’t want NorthGauge to be kept a secret.  Our extensive team of expert, carefully selected physician reviewers, supported by our highly experienced peer review executive team, are exceptional decision support resources. We have deployed our services to identify compliance risk (medical necessity); to peacefully settle disputes between hospital and patient; to counter insurance claims denials; and to support a merger and acquisition due diligence.  We’ve helped many hospital attorneys and risk managers determine whether or not to defend a claim and, of course, assisted hundreds of medical staff leaders and physicians in traditional peer review matters—in some cases all the way through fair hearing.

A growing number of clients now consider using NorthGauge any time an outside, objective, credible opinion about patient care is needed.  Given its potential value across multiple disciplines, doesn’t it make sense to introduce external peer review resources to others?  This supports development of sound strategies, regardless of the department or discipline in need.

In support of the best patient care and risk mitigation, consider introducing NorthGauge to your colleagues as a powerful resource given the multitude of applications and undeniable value of high integrity physician peer review.