Healthcare Provider Peer Review, 2nd edition details information and tools needed for an effective peer review program by any medical organization. It includes policies & procedures, competency and behavioral assessment tools and strategies, Committee structure, medical staff resources, legal resources and web links. Managing the disruptive physician or other healthcare provider is a renewed JCAHO focus in 2006. Extensive references and resources are also included.

Contents

Preface, Disclaimers

Medical Staff Services

Introduction to Peer Review

Mental Illness

Key requirements of the HCQIA of 1986

Immunity from damages

National Practitioner Data Bank

Reportable NPD actions - table

The Healthcare Integrity and Protection Data Bank (HIPDB)

Web resources related to data banks

State statutes protecting peer review

New case law

Fair Hearing and Appeal Rights for all staff

Criminal Background Checks

‘High risk’ providers – the impaired physician

Burnout

Physician well-being

Early detection

Confronting aberrant or disruptive physician behaviors

Detection related to the staff application process

Focused reviews

Rehabilitation Programs

Legal notes

Provider sanctions

Sanction levels

Peer Review Plan

Routine biennial performance evaluation

Non-routine practitioner peer review – corrective action

Fair Hearing Plan and Appellate Review Procedures

Dispute Resolution

Confidentiality, Indemnification and Immunity

Confidentiality Statement Examples

Scoring System for Peer Review

Peer Review Committee minutes – example format

Peer review confidentiality safeguards

Corrective Action Plan – specific to an individual practitioner

Cautions regarding the peer review process

Physician/physician or other professional colleague peer evaluation form

Physician performance evaluation process; Santa Barbara Medical Foundation

Quality Assessment Review Form

Physician Profiling to Measure Clinical Performance

Physician Chart Review Profile Form

‘Boot Camps/Traffic Schools’ for “dyscompetent” physician

References and Resources

Selected ‘benchmark’ case law citations

Web Site Resources - Medical staff bylaws, rules and regulations; Peer review

Legal Briefs