Executives can learn to recognize conflict of interest in peer review and follow a best-practices approach to dealing with it in an educational, non-punitive manner.  Peer review in hospitals continues to break down largely as a result of conflict of interest (COI), which results in oversight committees failing to identify and deal with poor-performing physicians. This problem should and can be solved, according AllMed Healthcare Management.

Andrew Rowe, AllMed’s CEO, described how hospital leaders can root out the causes of peer review conflict of interest and pursue a strategy of transparency, accountability, and non-punitive remediation. His comments were the focus of a recent webinar, and are featured in a published paper in a leading healthcare industry publication.

“In every hospital, a small but significant percentage of doctors make incorrect diagnoses or poor procedural decisions, leading to complications, injuries, even patient deaths.” This can all be avoided, Rowe said “if hospital leaders better understand peer review, and take the necessary steps to ensure that their peer review programs have specific mechanisms for identifying and eliminating conflict of interest. This includes the board, the administration, and MEC and peer review committee.”

When conflict of interest infects the peer review process, the consequences can be catastrophic for the hospital. As evidence, widespread attention has been drawn to the case of a medical center in California which paid $500 million in negligence awards and subsequently closed after administrators blocked from peer review, instances where cardiologists had performed unnecessary procedures and operations on more than 600 patients. In another instance, a Maryland hospital reached a $22 million settlement with Medicare for illegal kickbacks it paid to a cardiology practice in exchange for patient referrals.

“These are just a few examples of the damage that conflict of interest can do,” Rowe said. “These are preventable situations; but hospital executives and boards must recognize the critical role they play and the need to take action.”
Rowe describes what he views as an effective peer review program. When properly implemented, it addresses the aforementioned problem in the following ways:

• Establishes a leadership culture of transparency and accountability, where hospital boards and executives ensure there are systems that measure and monitor physician performance, and where all constituents learn to recognize and take action to eliminate both real and apparent conflict of interest in peer review.
• Clarifies for leaders and administrators what specific factors lead to conflict of interest. Among these are social and economic relationship pressures between peer review committee members and physicians, hierarchies of authority and influence and the unwritten rules that govern behavior in medical staff organizations.
• Operates from well-developed and communicated by-laws and procedures which explain how to identify and address real or apparent conflict of interest, and how to properly select and train peer review committee members in order to eliminate it.
• Treats peer review as an educational tool, ensuring for example that physicians conducting reviews are educated about all conflict of interest issues, and know how to engage leadership when a conflict exists.

AllMed emphasizes that hospitals should consider complementing their internal peer review efforts with a carefully-chosen external review program. Among the reasons for doing this is that an external review entity can help in situations where the use of internal reviewers compromises a hospital peer review committee’s objectivity. Further, external peer review organizations typically employ more non-conflicted specialists than would be on staff at a small or medium-sized hospital. This ensures that the performance of a physician in a particular specialty can be reviewed by another physician in that same specialty.

About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited independent review organization (IRO) serving leading hospital groups, ASCs, insurance payers, and medical management firms, nationwide. More than 400 licensed and board-certified physicians in active practice conduct AllMed’s evidence-based peer reviews. The company’s hospital peer review services help hospitals supplement their internal peer review processes to meet or exceed The Joint Commission standards for ongoing and focused peer reviews. More information about AllMed can be found on the company’s Web site at http://www.allmedmd.com.

Source: PRWEB