Comprehensive Reviews:
Comprehensive physician peer review is a process in which a physician’s clinical performance, medical decisions, and adherence to professional standards are evaluated by their peers, other physicians within the same specialty. This type of review is designed to promote quality improvement, enhance patient safety, and maintain high standards of care within healthcare organizations. QPS offers narrative external peer review reports, which provide an in-depth evaluation of practitioner performance on a specific case or group of cases. Elements of the review include a Summary of the Clinical Course, answers to client questions, and complete rationales for each determination.
Focused Reviews:
Focused physician peer review typically targets specific aspects of a physician’s practice rather than evaluating their overall clinical performance. This type of peer review is often conducted in response to a particular concern or issue related to a physician’s practice. These reviews consist of scored summaries of individual cases using a standard numerical rating system. Cases are evaluated against specialty-specific criteria and tabulated and presented in a Physician Peer Review Summary, which is in spreadsheet format. For programs involving multiple practitioners, a Group Evaluation Summary is provided. No narrative responses are provided.
OPPE/FPPE Reviews:
Ongoing physician practice evaluation (OPPE) and focused physician practice evaluation (FPPE) are standard protocols that healthcare organizations must follow at the established intervals. All hospitals and healthcare organizations evaluate providers’ performance and competence based on their bylaws and regulatory body’s standards. Creating and maintaining an effective FPPE and OPPE programs is essential to allow providers to improve. QPS supports healthcare organizations by providing reliable, objective reviews to evaluate quality, safety, and/or appropriateness of provider’s care.
Medical Necessity Reviews:
Medical necessity reviews are conducted to determine whether a proposed medical treatment, procedure, or service is appropriate and essential for a patient’s diagnosis or condition. These reviews help ensure that healthcare resources are used efficiently and that patients receive the most appropriate care based on established medical criteria. QPS support healthcare organizations and insurance companies to evaluate whether the proposed healthcare service is medically justified and meets the criteria for coverage or reimbursement.
Fair Hearing support:
Fair hearing refers to an administrative hearing in a hospital or professional association. The Fair Hearing process is coordinated by the hospital medical staff and aims to provide due process when it comes to the provider’s privileges and medical staff membership. Quality Peer Solutions can support the process by providing a clinical review of cases, discussing the evidence-based standards of care, and by providing expert witnesses or consultants when needed.
