Peer Review System Evaluation
The NPRC Peer Review System Evaluation (PRSE) is an objective, external analysis of the operations of a hospital’s peer review system. NPRC identifies peer review system breakdowns and provides the hospital with the information and recommendations necessary to establish an effective peer review system.
In addition to increasing the quality of patient care and reducing liability, a PRSE can assist the hospital in addressing the confusion resulting from the growing reliance on publicly available internet hospital rating services. Due to the realities of the internet driven marketplace, companies, health plans and patients are being prompted to make provider selection decisions based upon ratings that fail to distinguish between aberrant practice patterns that reflect difficult cases and seriously ill patients and those that indicate problematic cost/quality issues.
Therefore, the current environment demands that hospitals be able to make this distinction internally and objectively demonstrate to the marketplace that out-of-norm patterns do not reflect cost/quality issues or take action to rapidly redress true problems.
The internet accelerates the pace at which marketplace changes occur. Quick response by a hospital is essential to preserving its economic viability and internal peer review systems are often unable to meet the challenge. The findings and recommendations provided in the NPRC Report of the PRSE ensures that the hospital has the information necessary to implement a peer review system that can quickly and effectively meet this challenge.
Conduct of Peer Review System Evaluation
The NPRC Peer Review System Evaluation (PRSE) is conducted in three (3) phases:
Phase I
NPRC conducts a complete review of the hospital’s peer review system. NPRC performs an on-site investigation, including interviews with key medical staff and administrative personnel, and a thorough review of relevant documents and data to assess the hospital’s current peer review system.
This assessment is set forth in the NPRC Report, which is reviewed by NPRC’s legal counsel, and details the current operation of the peer review system. The Report clearly identifies any system breakdowns and provides recommendations to increase quality of care and patient safety and assist the hospital in avoiding liability.
Phase II
Based upon the findings and recommendations contained in the NPRC Report, the hospital develops a Corrective Action Plan. The Corrective Action Plan typically includes the development and implementation of a new or modified peer review system. The hospital may develop its own peer review system or adopt the NPRC Peer Review System and tailor it to the hospital’s structures, services, data capabilities and political environment.
To effectively implement the new or modified peer review system, NPRC recommends that the hospital incorporate the description of the peer review system into a Peer Review System Manual. With the Manual, the peer review system has a single resource for peer review authority and a detailed description of the operational conduct of peer review to provide day-to-day guidance for the participants.
NPRC is available to assist the hospital in the development of a peer review system or provide the hospital with the NPRC Peer Review System.
Phase III
Upon the request of the hospital, NPRC will assist in the implementation of the new or modified peer review system and training of the peer review participants in its operation. The Peer Review System Manual is an effective tool in facilitating this process.