In theory a group your peers are supposed to look after your interests as a member of the peer group.But in practice it is not so. it no longer the Noble act of quality or protection of patients or professionals.
Medical staff peer review, an integral part of a hospital’s operation, should be an integral part of a physician’s practice. When it leads to "corrective action" against a physician’s hospital privileges, peer review has ramifications far beyond the walls of the hospital, involving not only the Medical Board and the National Practitioners Bank but also malpractice carriers and third-party payers to whom the affected physician must self-report. Ultimately, a physician against whom corrective action is taken can lose hospital staff privileges and be faced with a Medical Board disciplinary action, loss of malpractice insurance, and loss of provider status with the very people who pay for the physician’s services to patients. Thus, it should be clear to all physicians that peer review is a serious business.
Market forces have shifted the economic power in the practice of medicine
Along with mutual necessity, a host of potential problems exist between hospitals and physicians: Non-compliance with hospital rules and regulations, medical staff politics, and economic credentialing are some of the more obvious pitfalls.
In the last 20 years, because of managed care, the economic power has shifted from physicians to hospitals, third-party payers and other health institutions. Whereas, in the past, hospitals depended on fee-for-service physicians to supply patients, now physicians are dependent upon health care institutions owned by hospitals.
What this means in the operation of hospitals’ peer review systems is that they are all too often driven by economic motives. While the law provides that physicians should be admitted to membership of medical staffs and accorded privileges based solely on their professional qualifications, any practicing physician or health care lawyer knows that admission to and termination from the staff involve issues of economic consideration, not just professional competence. In other words, hospital peer review is human; it has all of man’s imperfections in spite of the idealistic concepts found in the law and in the medical staff bylaws.
For example, competent physicians who take care of Medicare and Medi-Cal patients or patients whose care is uncompensated seem to have a higher incidence of peer review difficulties. It appears as though some hospitals, whether they will admit it or not, actively discourage the admission of patients who cannot pay for their care. Under this policy, the hospital has allies in the hospital-based physicians who likewise would not be paid by these patients for the value of their services. In our experience, physicians who admit these types of patients are subject to hostile peer review at an alarmingly higher rate than their colleagues who do not.
On the other hand, sometimes peer review unfairly strikes physicians with the most lucrative practices. In this situation, peer review can be a result of economic jealousies by colleagues in the same specialty. These are just two examples of the economic influences on peer review. It is important that peer review be conducted fairly and evenhandedly without regard to these economic factors.
Medical staff peer review, an integral part of a hospital’s operation, should be an integral part of a physician’s practice. When it leads to "corrective action" against a physician’s hospital privileges, peer review has ramifications far beyond the walls of the hospital, involving not only the Medical Board and the National Practitioners Bank but also malpractice carriers and third-party payers to whom the affected physician must self-report. Ultimately, a physician against whom corrective action is taken can lose hospital staff privileges and be faced with a Medical Board disciplinary action, loss of malpractice insurance, and loss of provider status with the very people who pay for the physician’s services to patients. Thus, it should be clear to all physicians that peer review is a serious business.
Market forces have shifted the economic power in the practice of medicine
Along with mutual necessity, a host of potential problems exist between hospitals and physicians: Non-compliance with hospital rules and regulations, medical staff politics, and economic credentialing are some of the more obvious pitfalls.
In the last 20 years, because of managed care, the economic power has shifted from physicians to hospitals, third-party payers and other health institutions. Whereas, in the past, hospitals depended on fee-for-service physicians to supply patients, now physicians are dependent upon health care institutions owned by hospitals.
What this means in the operation of hospitals’ peer review systems is that they are all too often driven by economic motives. While the law provides that physicians should be admitted to membership of medical staffs and accorded privileges based solely on their professional qualifications, any practicing physician or health care lawyer knows that admission to and termination from the staff involve issues of economic consideration, not just professional competence. In other words, hospital peer review is human; it has all of man’s imperfections in spite of the idealistic concepts found in the law and in the medical staff bylaws.
For example, competent physicians who take care of Medicare and Medi-Cal patients or patients whose care is uncompensated seem to have a higher incidence of peer review difficulties. It appears as though some hospitals, whether they will admit it or not, actively discourage the admission of patients who cannot pay for their care. Under this policy, the hospital has allies in the hospital-based physicians who likewise would not be paid by these patients for the value of their services. In our experience, physicians who admit these types of patients are subject to hostile peer review at an alarmingly higher rate than their colleagues who do not.
On the other hand, sometimes peer review unfairly strikes physicians with the most lucrative practices. In this situation, peer review can be a result of economic jealousies by colleagues in the same specialty. These are just two examples of the economic influences on peer review. It is important that peer review be conducted fairly and evenhandedly without regard to these economic factors.
No comments:
Post a Comment