10 Myths and Truths in Same-State Peer Review

| | Physician Peer Review

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Same-State Peer Review
For several years, many workers’ compensation and utilization review (UR) industry stakeholders have been pushing for same-state licensure. These people believe that physicians should be licensed by their own state’s medical board — rather than another state’s medical board — in order to conduct UR peer reviews.

Many of the arguments in favor of same-state licensure are only partially sound — or are completely false. By looking at 10 common reasons proponents want to require same-state licensing for peer reviews, we can conclude that same-state licensure improves neither the quality of peer review decisions nor treatment outcomes. The same-state question, unfortunately, may defer focus from the important question: How we can ensure high quality of peer review. To start, we should consider two important regulatory provisions:

• Disallow peer reviewers who have had their license suspended or removed in any state — not just their own state,

• Implement a process to refer poor practice decisions or lack of objectivity to the state in which the peer reviewer has his license.

For more thinking on the myths and truths in same-state peer review, see my full article on riskandinsurance.com

Lisa Hannusch

Lisa Hannusch is CEO of UniMed Direct and founder of UR Nation. With experience in virtually every aspect of workers' compensation medical management, she is a nationally recognized authority on effectively managing utilization and medical claim issues. Lisa has direct experience as a healthcare provider, has conducted healthcare fraud investigations leading to prosecution, designed claims and medical software applications, and has worked as an insurance regulator and state agency rule and guideline author. She was an influential leader for requiring evidence-based medical determinations. At UniMed Direct, Lisa has built an industry leading managed care company specializing in ReviewStat – a leader in hosted medical management software, supported with services for UR and a national independent Peer Review Panel.