Outsource Hospital Peer Review to an Independent Review Organization
Today, many hospitals are looking to independent review organizations to provide hospital peer reviews on sentinel events and bad outcomes that occur in their hospital. Why? Well it's no secret that the peer review process often does not work very well inside hospitals for a couple of reasons. First, all physicians are too busy working on patients and so peer reviews never get done. Second, there is a lot of conflict of interest associated with peer review committees. Hospital staffs have competitive pressures among the doctors working there. Oftentimes this can lead to unfair determinations against a doctor for competitive reasons.
Outsourcing hospital peer review cases is an emerging a best practice. Many hospitals are routinely sending their most difficult and complex sentinel events out for review to independent review organizations because they know they can get an objective non-conflicted decision and fast turn around time. Most hospitals are using IROs today for hospital peer reviews systematically send cases out and have developed standard criteria about deciding which cases to send out as opposed to letting them languish in peer review committees.
Oftentimes conflicts of interest can not be dealt with effectively inside the peer review committee environment. Many times, the chief medical officer or medical director who is responsible for the case makes attempts to keep cases in house…so there is some resistance to sending out cases to IROs initially. But, organizations that have decided to try IROs have found them to be highly effective in rendering effective objective, unbiased medical decisions using like specialists who base their decision on medical facts.
As an example, smaller and medium sized hospitals in rural areas have a difficult time getting peer review done because of a lack of available specialists, so they often outsource their peer review to independent review organizations. We're performing hospital peer review for dozens and dozens of such rural hospitals across the United States with a high degree of effectiveness.
If your organization has not yet decided to outsource medical peer reviews to an independent review organization, you might want to consider trying it. If you do, you'll most likely come to the following conclusion: Outsourcing your medical peer review cases to an IRO is a best practice and something that should be adopted.
About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its independent medical review and hospital peer review services
includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed Medical News Blog
and the Independent Review Organization Blog