Internal Peer Review
As far as I can tell, few hospitalist groups conduct any sort of formal peer review. Most seem to rely on the hospital’s medical staff peer review to encourage quality of care and address shortcomings; the review is often coupled with a salary incentive paid for good performance on certain quality metrics. While these reviews are of some value, I think they are pretty blunt instruments. Every hospitalist practice should think about developing a more robust system of peer review for their group.
Review Categories
Assessment of each provider’s individual performance, whether they are an MD, nurse practitioner, or physician assistant, can be divided into three general categories. The first is the traditional “human resources” category of performance, which includes whether the person gets along well with others in the practice as well as other hospital staff, patients, and families. Does the person arrive at work when scheduled, manage time effectively, and work efficiently? Do nurses and other hospital staff have compliments or complaints about this doctor?
The second category of performance can encompass the hospitalist’s business and operational contributions to the practice. Do they document, code, and bill visits correctly? Do they attend and participate in meetings and serve on one or more hospital committees?
The third category assesses measurable quality of care. This could include an assessment of mortality, readmission rate, performance on such quality metrics as core measures, and performance on selected initiatives (e.g., appropriate VTE prophylaxis). Aggregate data for these measures can be difficult to attribute to a single hospitalist, so this may require a review of individual charts instead of relying on reports generated by the hospital’s data systems.
A number of metrics might apply to more than one of the three categories. For example, documenting accurate medicine reconciliation can be thought of as both a quality issue (good for patients) and a business issue (e.g., your hospital might provide a financial reward to your group for good performance). Ensuring the referring physician is “CC’d” on all dictated reports is both a quality and business issue. It really doesn’t matter which category you put these in.
The categories I have listed, and the sample items in each, are intended as examples. You should think about the unique attributes of your practice and its current priorities in order to develop the best internal peer review system for your group. You probably will want to change metrics periodically. For example, you may choose to focus on VTE prophylaxis for now, but at some point it may make sense to replace it with a new metric, such as glycemic control.
