Eliminating Conflicts of Interest in Medical Peer Review Cases


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It’s a well known fact that medical peer review inside hospital and medical groups is at best complicated and at worst highly conflictive in terms of its outcomes. Medical peer review is inherently a broken process that can lead to conflicts of interest in many cases. As a result, medical peer review frequently does not get done or gets swept under the rug in hospital environments.

Why is this conflict of interest so great? Most hospitals don’t have much depth of knowledge in each specific specialty area, and often, the physicians on a peer review panel who are in the best position to evaluate their colleagues are conflicted by either friendship or competitive forces to make a determination that is not completely based upon the medical fact involved in the case. As a result, conflict of interest is one of the most difficult aspects to overcome when rendering effective peer reviews in a hospital environment. Most risk and quality managers in the hospital environment understand this fact, and an increasing number of them are turning to an independent review organization to provide hospital peer reviews on an outsourced basis.

Outsourcing to a third party IRO immediate eliminates any the conflict of interest and it speeds up case resolution. Why? First of all, the independent review organization can deploy a panel of specialists of all specialty and sub-specialty areas as well as allied group of board certified active practice licensed physicians. The independent review organization can quickly match a specific peer review case with a specialty or subspecialty from its own panel and assure that the specialist that is reviewing the case materials is not engaged in any conflict of interest situation. Oftentimes panels are made up of specialists from across the country so it’s very easy for an IRO to select a specialist from a different state where this is no possibility that there’s a conflict. Secondly, all the cases are done completely anonymously and as a result of this, a peer specialist on an IRO panel is able to maintain anonymity and therefore provide a high level of objectivity in their case review.

Hospitals that are looking to improve the quality of care improve patient’s safety and deal with sentinel events and negative outcomes on a more expeditious and efficient basis are using IROs to provide outsourced hospital peer review. We have dozens of clients, including hospitals from the largest medical groups in the United States, which are now adopting this as a best practice. Most of the hospitals that we initially dealt with for the first time were in very sensitive situations where they were already in litigation over a specific issue of a bad outcome related to a physician misdiagnosis or mistreatment.

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 .


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