Effective Peer Review

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Effective Peer Review

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Effective Peer Review: The Complete Guide to Physician Performance Improvement, Third Edition

Robert J. Marder, MD    

Peer review continues to rate as a top challenge in healthcare organizations. Even if they are meeting regulatory standards, most organizations struggle to develop a peer review program that is meaningful to physicians, causing them to resist this performance measurement tool.

This new edition explains the connection between peer review, OPPE, and FPPE. It also contains updated information on OPPE and FPPE as related to The Joint Commission’s standards.

This book also incorporates three previous books: Effective Peer Review, Peer Review Best Practices, and Measuring Physician Competency. Now readers have one, all-encompassing resource to answer their peer review and physician performance questions.

This completely updated book will help you:

  • Engage physicians in the peer review process
  • Create tools to recognize and celebrate excellence
  • Design OPPE profiles and create a plan for distributing the information to physicians
  • Eliminate bias and improve case reviewer efficiency
  • Determine if your peer review policies comply with regulatory standards

About the Author:

Robert J. Marder, MD
President, Robert J. Marder Consulting, LLC

Dr. Marder brings more than 30 years of healthcare leadership, management, and consulting experience to his work with physicians, hospitals, and healthcare organizations nationwide. A highly respected speaker, consultant, and author, he has assisted hundreds of hospital medical staffs in evaluating and improving their approach to peer review and physician performance measurement.

Published: May 2013

Table of Contents:

Chapter 1: Peer Review: Why Do We Need to Measure Physician Competence?

  • What Peer Review Is
  • What Peer Review Is Not
  • Who Is a Peer?
  • Impartiality and Conflicts of interest
  • Sham Peer Reviews
  • The Duty to Perform Effective Peer Review
  • Should Physicians Be Paid to Perform Peer Reviews?

Chapter 2: From Punitive to Positive: Creating a Performance Improvement Culture for Peer Review

  • How Can Culture Change?
  • Values of a Performance Improvement–Focused Peer Review Culture
  • Peer Review and the Just Culture

Chapter 3: Legal Considerations: Impact of Regulations and Liability on Peer Review

  • Redefining Peer Review: OPPE, FPPE, and the Core Competencies
  • How the Standards Apply
  • Peer Review Protection Laws
  • Affirmative Duty to Keep Information Confidential
  • Fair Hearings
  • The National Practitioner Data Bank
  • Negligent Peer Review

Chapter 4: Peer Review Structures: The Impact of Multi-Specialty Peer Review 

  • Peer Review Structures: Three Primary Functions
  • Goals for Peer Review Redesign
  • Basic Peer Review Models
  • Who Should Oversee Peer Review?
  • Selecting the Right Model
  • Physician Behavior: Who Should Handle It?

Chapter 5: Measuring Physician Performance: What to Measure and How to Do It Fairly?

  • What Is a Physician Performance Indicator?
  • Indicator Validity: Selecting Physician-Driven Measures
  • What Are You Required to Measure?
  • What to Measure: Structure, Process, and Outcome
  • How to Measure Physicians Fairly: Review, Rate, and Rule Indicators
  • Understanding and Improving Risk- Adjusted Data
  • Using Perception Data to Evaluate Physician Performance
  • Case Study Indicator Selection

Chapter 6: Case Review: Reducing Bias and Improving Reviewer Efficiency and Effectiveness

  • Standardizing the Case Review Process
  • Case Identification and Screening
  • Physician Reviewer Assignment
  • Physician Review and Initial Case Rating               
  • Initial Committee Review and Physician Input    
  • Committee Decision and Improvement Opportunity Identification
  • Communication of Findings and Follow-Up Accountability
  • Case Rating Systems
  • Case Review and the Electronic Age

Chapter 7: Selecting Physician-Driven Measures for OPPE: Understanding and Applying the Six Core Competencies

  • ACGME, ABMS, and The Joint Commission: Where Did the Core Competencies Come From and How Are They Used?
  • Alternative Frameworks to the Core Competencies
  • Using the Competency Statement and Expectations to Drive Physician Performance Measures
  • Applying the Core Competencies to OPPE

Chapter 8: Physician Data Attribution: Making OPPE Data Meaningful to Individual Physicians

  • Using Imprecise Data for OPPE
  • Attribution and Case Review
  • Improving Attribution for Process Measures
  • Outcome Measure Attribution in a Multiple-Provider World
  • Attribution and Patient Satisfaction Data

Chapter 9: Evaluating OPPE Data: Using Benchmarks and Targets for FPPE and the Pursuit of Excellence

  • Understanding Normative Data
  • Interpreting OPPE Data for a Time Interval
  • How to Set Indicator Targets
  • Targets for Indicator Types
  • Interpreting OPPE Data for Trends

Chapter 10: From OPPE to FPPE: Creating Accountability for Physician Performance Improvement

  • Accountability for FPPE Initiation, Monitoring, and Follow-Up
  • Designing an Effective FPPE Plan
  • Getting Physician Buy-In for Improvement Opportunities and FPPE
  • What Happens If FPPE Fails?

Chapter 11: OPPE Profiles and Physician Performance Feedback:
Practical Principles for Competency Report Design and Distribution

  • OPPE Profile and Physician Performance Feedback Report: What Is the Difference?
  • Designing the Report
  • Define the Principles: 10 Questions to Guide Your Design
  • Create a Format That Reflects the Design Principles
  • Preparing and Distributing Competency Data Reports
  • Develop the Infrastructure and Support Materials
  • Pilot-Test Your Design
  • Create a Policy for Physician Competency Reports

Chapter 12: External Peer Review in a Physician Improvement Culture

  • EPR Uses
  • The EPR Policy
  • What Circumstances Typically Require EPR?
  • Who Determines When EPR Is Needed?
  • Who Will Select the Reviewer?
  • How Will the Cases Be Selected?
  • Who Will Review the EPR Report Findings?
  • How Will the Results Be Used?
  • Beyond Case-Based EPR: Physician Assessment Programs

Chapter 13: Reporting Peer Review: What Does the Board Need to Know?

  • Contemporary Board Accountabilities for Hospital Quality
  • What Keeps the Board Awake at Night?
  • Filling In the Knowledge Gap: Helping Boards Understand Physician Competency Measurement
  • What Data Should the Board Get?

Chapter 14: Running an Effective Peer Review Committee Meeting

  • Elements of an Effective Meeting
  • Role of the Committee Chair
  • Responsibilities of Committee Members in Meeting Preparation and Management
  • Practical Tips for Managing Committee Discussion to Avoid Wasting Physician Time

Chapter 15: Beyond the Hospital Walls: Peer Review in Ambulatory Care and ACOs

  • Why Would You Want to Do Peer Review in a Nonhospital Setting?
  • Can You Do Peer Review in the Nonhospital Setting?
  • What Data Can You Obtain From the Hospital and What Are You Willing to Share?
  • Peer Review Outside the Hospital: How Should You Organize It?
  • Peer Review Outside the Hospital: What Can You Measure?

Chapter 16: Creating Effective Peer Review Policies and Procedures

  • What Do Your Policies and Procedures Need to Cover?
  • Redesigning Your Peer Review Program: A Step-by-Step Guide
  • Should You Do This Yourself or Get Some Help?