Report 24

In 1994, the MMA formally introduced its peer review program. This program is comprised of two parallel programs: the "external" review program and the "internal" review program. The "internal" review program, directed by the Professional Performance Review Committee, provides a means of resolving complaints and inquiries the association or a component medical society receives from patients regarding MMA members. The "external" review program, directed by the Peer Review Program Committee, provides impartial peer review on a contractual basis to requesting health care facilities that need assistance with the investigation phase of their peer review activities. This report describes the activities of the "external" review program and its oversight committee, the Peer Review Program Committee.

The "external" peer review program offers two types of services to facilities requesting assistance: an onsite review service and a medical record review service. The Peer Review Program Committee oversees the activities of both of these services.

For the second year in a row, the Peer Review Program Committee did not receive any requests to perform a peer review or medical record review consultation. As you may recall, last year the committees suggested that should this trend continue, it would be the committee's recommendation that MMA leadership evaluate the wisdom of continuing to offer this service.

There may be a number of reasons for the lack of activity in the program. Primarily, since the Peer Review Program's inception in 1994, there has been a much greater emphasis by hospitals and clinics to establish and make use of peer review or quality review committees within their organization. Therefore, the need for outside peer review services has been diminished considerably. In addition, over the past seven years, a number of national organizations performing peer review services have been established in response to federal requirements under the Health Insurance Portability and Accountability Act (HIPAA) as well as mandates under Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation standards for hospitals. This may also account for the decreased demand for the MMA's services.

In developing their recommendations for the MMA budget for the upcoming year, the MMA Committee on Administration and Finance suggested discontinuing the External Peer Review Program. The committee was aware of the diminished use of the program, and cited the fact that there have been only ten contracts for services over the past seven years, and only three contracts within the past four years. Furthermore, since there have not been any new physicians trained as reviewers for the program in the past four years, additional expenses would need to be generated to train physicians if the program were to continue. Finally, the committee suggested that the annual liability insurance the MMA must carry for this program is not justified in light of the lack of interest in and utilization of the program. The insurance premium has increased considerably each year, and would be approximately $10,500 for the upcoming year.

At their July 21, 2001, meeting, the MMA Board of Trustees approved the Committee on Administration and Finance's recommendation and has not funded continuation of the program for the upcoming year. It is anticipated that MMA staff will continue to assist hospitals and clinics that contact the MMA seeking peer review services, should those requests arise. Staff maintains a list of other companies that offer peer review and quality review services.

I have appreciated the time and commitment by committee members to this project: Robert Bosl, M.D.; Kenneth Dedeker, M.D.; Melvin Sigel, M.D.; and Ronald L. Villella, M.D.

Paul F. Bowlin, M.D.
Chair

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