The Art of Creating a Physician Peer Review Panel, Part 2

| | Utilization Review

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Kats March 2018 Article on Physician Advisor Panel
In Part 1 of this series, I discussed creating a physician peer review with regard to determining the candidates for the panel and some basic steps to credentialing. Once you have a candidate who passes the credentialing process (limited or no malpractice issues, no sanctions against their license, etc.) the next step is contracting and training.

Contracting is vital to ensuring that both parties agree to the essential elements of the relationship. Many companies have different philosophies surrounding contracting that direct the need for the specific terms and conditions. A few of these are:

  • Length of the agreement
  • Scope of services to be performed
  • Reimbursement for the services
  • Terms and conditions
  • Service level agreement terms
  • Indemnification

We are fortunate to have a great medical management software platform, ReviewStat®, which tracks our credentialing documents and requirements. This makes it easy to produce the documentation for audit purposes and track our re-credentialing activities.

Once the physician is under contract it’s time for the training to begin. In addition to the medical director training the doctor on accreditation guidelines, the medical director should also be involved in the interview process, establishing a training program, and providing additional documentation related to specific treatments.

Our experience shows that ongoing training and communication with the medical director and support staff is necessary to ensure a quality product for our clients. It also allows us to determine if physicians have a continuing desire to remain participants on our panel. I suggest also exploring many options from a training and communication perspective, including newsletters, Web-Ex (or similar) sessions, round table participation, and other engagement.

Developing a peer panel takes time and attention to many details and ultimately is a very hands-on experience to ensure the expectations are communicated clearly and the execution of those requirements are verified regularly. When the process is working well it’s very gratifying for our organization, the participating physicians and our clients.

Karen Atkins

Karen Atkins, Chief Operating Officer with UniMed Direct, is leading the conversation, and the industry, on how to make the utilization review process more efficient for all stakeholders: physicians, insurance companies and, most importantly, patients.