Comprehensive Review
Comprehensive physician peer review evaluates a provider’s clinical performance, medical decisions, and adherence to professional standards by peers within the same specialty. This process supports quality improvement, enhances patient safety, and helps maintain high standards of care within healthcare organizations. QPS delivers narrative external peer review reports that provide an in-depth evaluation of practitioner performance for a specific case or group of cases, including detailed rationales and clinical insights.
Focused Review
Focused physician peer review examines specific aspects of a provider’s practice rather than overall performance. Typically conducted in response to a particular concern, these reviews provide scored summaries of individual cases using a standard rating system. Each case is assessed against specialty-specific criteria and presented in a Summary Report format. For programs covering multiple practitioners, a Group Evaluation Summary is also provided to facilitate comparative analysis and trend assessment.
Ongoing Professional Practice Evaluation (OPPE):
Ongoing Professional Practice Evaluation (OPPE) is a required protocol under healthcare organization bylaws and regulatory standards, designed to assess provider performance and competence over time. QPS supports both inpatient and outpatient settings, including FQHCs, by providing reliable, objective, specialty-specific reviews that ensure regulatory compliance, optimize provider performance, and enhance overall patient care. By maintaining strong OPPE programs, organizations can confidently demonstrate accountability while enabling providers to continuously improve their clinical practice.
Performance Improvement Review
These reviews go beyond traditional peer review to focus on organizational quality and safety outcomes. They include evaluations of mortalities, readmissions, quality outcomes and nursing care practices. Reviews can be conducted as individual case reviews, pattern reviews, or trend analyses, providing insights into both specific events and broader systemic issues. This approach helps identify opportunities for process improvements, supports compliance with regulatory standards, and enhances overall patient safety and quality of care.
Medical Necessity Review
Medical necessity reviews determine whether a proposed treatment, procedure, or service is appropriate, essential, and consistent with evidence-based guidelines for a patient’s diagnosis or condition. For health plans, these reviews are critical in ensuring care is clinically appropriate, cost-effective, and aligned with established coverage criteria. QPS provides objective, expert evaluations to help payers make defensible, evidence-based decisions regarding coverage, reimbursement, and utilization management, while supporting quality care and resource stewardship.
Medical-Legal Peer Review
Medical-Legal Peer Review provides independent, objective evaluations of clinical care to support legal and risk management needs. These reviews are used in malpractice cases, liability assessments, regulatory investigations, and expert witness engagements. QPS delivers detailed, evidence-based reports that assess adherence to standards of care, clinical decision-making, and patient outcomes. Our evaluations help legal professionals make informed, defensible decisions while providing credible documentation for litigation, compliance, and risk mitigation.
