Improved Hospital Quality and Risk Management With An Independent Review Organization (IRO)

 


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Many risk managers inside hospitals view hospital peer reviews as an effective way to resolve sentinel events on a timely basis and reduce the potential for expensive lawsuits or sanctions. Risk managers view independent review organizations (IROs) as a part of the hospital peer review process. They use IROs as a tool that to improve their decision making regarding sentinel events and the adjudication of potential problems. Hospital peer review, when outsourced to an independent review organization, provides risk managers and quality assurance managers with the ability to quickly understand the facts surrounding a sentinel event or a series of events and allows the risk manager to get an objective review of a physician’s performance.

IRO objectivity benefits both the hospital and the physician. Indeed many physicians are worried about having their work reviewed by outsiders who don’t understand the context of their work or perhaps have never been inside the hospital environment where a particular procedure was performed. But having an outside independent review organization do these types of peer reviews is actually highly advantageous to the doctor because the medical facts associated with the case or series of cases are reviewed by a like specialist who has no bias. A fair and objective determination can be made without the need for an onsite visit.

Many hospitals insist that if a peer review organization reviews their cases then it must come onsite. This is actually a bad idea because the outside organization will have a tainted perspective, making them less able to render an objective unbiased determination. It is true that in some cases, it is important for a peer review organization to come onsite-particularly when they’re looking at systems and processes. But oftentimes the questions on a case are really related to physician performance and the most effective way to make those determinations is by reviewing the case facts and the medical charts, which can be done without an onsite visit.

An onsite visits are also expensive…frequently; it is cost prohibitive for hospitals that are trying to get peer review done. An independent review organization can provide a low cost alternative…by employing a specialist who is in active practice in a like specialty area without asking them to travel. In many cases specialists are extremely expensive and their day rates become cost prohibitive to have them come onsite to a hospital. After using an independent review organization for hospital peer review, most hospitals that have believed that they needed onsite reviews of their cases, have earned that it’s a lot more effective and less costly to use an IRO to review the case materials offsite.

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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