Hospitals that have come to us for the first time for medical peer review services often have cases that have been either in litigation or subject to potential litigation for months if not years. We have been able to quickly help litigation teams and hospital quality managers gain clarity about these situations so they can more easily decide what their next course of action should be. In cases of litigation, if a hospital knows that their physician provider was at fault in a particular situation that leads to a bad outcome or a sentinel event, it makes more sense to settle those cases quickly, rather than incur more legal expenses by continuing to defend themselves.
When hospitals first experience successful case resolution through an outsourced peer review, they begin to believe that outsourcing to an independent review organization can have lasting benefits and should be done on a more systematic basis. Applying ?best practices? and ?quality management? to the process means that an organization is trying to reduce negative patient outcomes and sentinel events and, as a result, it will send a certain percentage its peer review committee cases out to an independent review organization to be looked at. Oftentimes, our clients send us cases in groups where we?re asked not to look just at ?bad outcomes?.
The ?bad outcome? cases might be interspersed in a larger sampling of cases where nothing went wrong at all, assuring that our peer specialists are getting a representative sampling of cases allowing for a high degree of objectivity in the review. So many hospitals have gone from an initial experience outsourcing a sensitive case to an IRO to using an IRO as a part of an ongoing quality management process. A systematic, proactive approach to sending out sensitive cases has been done for oncology groups, radiology groups and other specialty groups inside hospitals. We also review samplings for other specialty areas including general surgery, orthopedics and neurosurgery-- all with great results. Today outsourced peer review for hospitals and medical groups is rapidly being adopted as a ?best practice.?
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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