You Ain’t From Around These Parts: Is There Value in Same-State Peer Review?

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Same-state peer review

What is the value of same-state licensure for peer reviews in workers’ comp utilization review?

Original article can be found on Risk & Insurance.

Today, only a few states require physicians to be licensed by their own state medical board in order to perform UR peer reviews. Based on the number of states that discuss or propose legislation to mandate same-state license requirements every year, it is evident that many participants believe that same-state licensed peer review would raise the quality of the medical process. But is this really the case?

This same-state legislative discussion detracts from the ultimate focus: quality peer review and ensuring that physicians understand evidence-based guidelines, are able to improve the quality of life of injured employees, and are equipped to help them return to work. When we evaluate the attributes of a quality peer reviewer, few scenarios suggest that same-state licensing would provide any benefit, and a few even suggest that same-state licensing would be a detriment. In short, same-state licensing adds cost and bureaucracy, and does not improve peer review quality.

For more thinking on 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.

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