How Many Cases Should Be Submitted for Focused External Peer Review?

February 15, 2019 | Posted in Healthcare Consulting

This is a common question, but ignores another key consideration:  What types of cases should we submit for external peer review?  Numbers and types of cases are essential considerations.   The key is to have the type and number of cases be consistent with the objectives of the review.  Begin with the end in mind.  Here are three basic questions that warrant answers early in the process when determining what cases, and how many, to send: 

What prompted our interest in external review?   

Was there a red flag?  Is the concern related to a single case, a pattern, one or more complaints, new privileges, contract performance? 

  1. Concern that is isolated to one adverse outcome typically results in the submission of that single case. 
  2. Concern over aberrant patterns might result in a larger, carefully selected set. 
  3. Concern over necessity for procedures typically starts with a probe sample followed by a statistically valid random sampling of cases. 

In other words, form should follow function. 

What questions are we trying to answer?

Leadership must clearly articulate the purpose of the review so all involved can work in support of the review’s objectives.   Committees should reach consensus on focal questions, which ultimately drives the number and type of cases required to appropriately answer them.

What might be done with the information provided by the external review? 

When leadership considers in advance the various scenarios, the review process has a better chance of being defensible.  Is corrective action a possibility?  Might we be in a federal self-disclosure situation?  Appreciating all possible outcomes will help in identifying the number and types of cases required for review in support of defensible decisions. 

Peer review cannot be a mechanical process.  Rather, it requires a strategic approach.  With our extensive experience and a proven methodology, NorthGauge Healthcare Advisors is well suited to assist you in identifying the right set of cases to submit for external peer review.