Outsource Hospital Peer Review to an Independent Review Organization

 


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Today, many hospitals look for Independent Review Organizations (IROs) to provide hospital peer reviews on sentinel events and bad outcomes that happen. It´s no secret that peer reviews often do not work well inside hospitals for several reasons: First, the hospital´s doctors are all too busy and simply make their peer reviews a lower priority. Second, doctors are uncomfortable reviewing any peer they work with regularly. Finally, there´s the conflict of interest associated with peer review committees. Hospital staffs have competitive pressures among the doctors working there. It´s not unusual that this can lead to unfair determinations against a doctor for competitive, or even personal, reasons.

Outsourcing hospital peer review cases is an emerging best practice. Many hospitals are routinely sending their most difficult cases out for review to independent review organizations. Using a third party, they know they will get an objective, non-conflicted decision and fast turn around time. Most hospitals that are using IROs today for hospital peer reviews systematically send cases out. They´ve also developed standard criteria about which cases to outsource instead of letting them languish in peer review committees. Sometimes conflicts of interest or personal relationships among doctors simply cannot be dealt with effectively inside the peer review committee.

When the chief medical officer or medical director who is responsible for the case tries to keep cases in-house, there is some resistance to sending out cases to IROs initially. But organizations that have decided to try IROs have found them to be useful for providing effective, objective and unbiased medical decisions with the help of 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 the lack of available specialists. So they outsource their peer review to Independent Review Organizations. AllMed performs hospital peer reviews for dozens and dozens of such rural hospitals across the United States, and with a high degree of effectiveness.

If your hospital has not yet decided to outsource medical peer reviews to an IRO, consider doing so. You'll be impressed with the results.

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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