Transcript Peer Review

Peer Review Overview
DEB KAZMERZAK, IOWA PCA
ACKNOWLEDGEMENT: LINDA RUBLE, PA/NP, PCA
CLINICAL CONSULTANT
Have you ever tried….?
IOWA PRIMARY CARE ASSOCIATION
Why do FQHCs conduct peer
review?
330 rules
Program requirements 3, 8
FTCA deeming
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Section 330 Authorizing
Legislation
The center will have an ongoing quality improvement system that
includes clinical services and management and that maintains the
confidentiality of patient records.
http://bphc.hrsa.gov/policiesregulations/legislation/index.html
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HRSA Program Requirement 3
Staffing Requirement: Health center maintains a core staff as necessary
to carry out all required primary, preventive, enabling health services
and additional health services as appropriate and necessary, either
directly or through established arrangements and referrals. Staff must
be appropriately licensed, credentialed and privileged. (PIN 2002-22)
http://bphc.hrsa.gov/policiesregulations/legislation/index.html
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PIN 2002-22
D. PRIVILEGING REVISION OR RENEWAL REQUIREMENTS
1.
The revision or renewal of a LIP’s privileges should occur at least
every 2 years and should include primary source verification of
expiring or expired credentials, a synopsis of peer review results for
the 2 year period and/or any relevant performance improvement
information. Similar to the initial granting of privileges, approval of
subsequent privileges is vested in the governing board which may
review recommendations from either the clinical director, or a joint
recommendation of the medical staff (including the Clinical Director)
and the Chief Executive Officer, or delegate this responsibility (via
resolution or bylaws language) to be implemented according to
approved policies and procedures (including methods to assess
compliance with these policies and procedures).
http://bphc.hrsa.gov/policiesregulations/policies/pin200222.html
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HRSA Program Requirement 8
Quality Improvement/Assurance Plan: Must include
Periodic assessment of the appropriateness of the utilization of services
and the quality of services provided or proposed to be provided to
individuals served by the health center; and such assessments shall. . .
◦ Be conducted by physicians or by other licensed health professionals
under the supervision of physicians;
◦ Be based on the systematic collection and evaluation of patient
records; and
◦ Identify and document the necessity for change in the provision of
services by the health center and result in the institution of such
change, where indicated.
http://bphc.hrsa.gov/policiesregulations/legislation/index.html
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Other Considerations…
Federal Tort Claims Act (FTCA)
◦ Requires QI/QA plan, which requires peer review
Blinded, aggregate results should be shared with health center board
Clear policies and procedures on who can see peer review results
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Frequently Asked Questions
How often?
How many charts?
How do you conduct peer review of specialists?
What about a single clinician practice? (i.e. one dentist)
There is no solid guidance
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Chart Audit vs. Peer Review
Not the same thing!
Chart audit
◦ Assesses completeness of documentation
◦ Could be administrative support staff
Peer review
◦ Requires clinical judgment
May be done together, as long as the person conducting the chart
audit/peer review is appropriately licensed
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How can peer review findings
help?
Shows the strengths and weaknesses
Provides supervisors data on training needs
Follow up data provides information on whether the training or other
efforts to improve the results paid off
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Closing Thoughts
Close the loop. This is not a task to be checked off the to do list, but an
opportunity for rich discussion among your clinicians and for
performance improvement, both at the individual clinician level and at
the health center level
This is also an opportunity to recognize outstanding performance of
clinicians/health center sites
RESOURCE: www.ecri.org
IOWA PRIMARY CARE ASSOCIATION
Thank you!
Deb Kazmerzak
Iowa Primary Care Association
[email protected]
515.333.5013