Healthcare organizations juggle a variety of priorities, but the one of most important is patient safety. And one of the main ways to keep patients safe is to ensure the physicians they’re working with are providing the best care. There are many ways to ensure physicians are performing to the best of their ability, and one of those methods is Peer Review. In this post, we’ll go over both Peer and Case Review, and look into strategies for accurately evaluating provider performance.
Healthcare organizations, through their medical staff, are responsible for the quality of care and patient safety. Peer Review is a process that helps healthcare organizations ensure they are providing the highest level of care and patient safety possible. Peer Review involves members of a medical staff within a healthcare organization participating in activities that measure, evaluate, and help to improve the performance of providers within the healthcare organization.
There are both federal and state protections in place for Peer Review.
To claim Peer Review protection, all Peer Review information must be treated as confidential and/or privileged. All documents, such as Case Review documents, must cite confidential and privileged protection. If an organization doesn’t cite protection language on its documents, or they make information available outside the review process, courts may find that the organization has waived its right to protection.
Case Review and Peer Review are related as case review is a medical staff–led initiative. Case Review is defined as:
A medical review in which the clinical care is cross checked against a specific set of standards, such as Medical Necessity Criteria. A reviewer (peer or physician) will look at a patient's level of care, intensity of treatment, and other care specifications to ensure that the care that was ordered, or provided by a physician or healthcare organization was appropriate and necessary.
A successful Case Review process usually involves eight best practice steps.
It is quite a monumental task, isn’t it? The good news is, there are ways to streamline the process to ensure nothing falls by the wayside. With HealthStream's Evaluate, you can view every provider in your health setting, while you measure and monitor their performance and share that data with relevant parties. Learn more about it here, and if you have any questions, we’re always here to help, just reach out.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.View All Learning & Performance
When you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.View All Quality & Compliance
Fulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.View All Products
HealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.View All Reimbursement
Learn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.View All Resuscitation
Expand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.View All Clinical Development
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.View All Products
Learn more about HealthStream's provider credentialing, privileging, & enrollment solutions for healthcare organizations.View All Credentialing
Make sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.View All Scheduling