Physician Peer
1,2,3
Review
A Practical Approach to the Focused
Professional Practice Evaluation (FPPE) Process
A Presentation for
Pomerene Hospital Physician Leaders
Kendall L. Stewart, MD, MBA, DFAPA
August 17, 2009
1I
hope to offer a practical perspective you can use to design and deploy your own effective peer review process.
going to describe our process as an example; I’m certain you can learn from our mistakes.
3I have a lot of peer review scars to show from my years of involvement in this process.
2I’m
Why do exceptional physicians insist on
participating in a vigorous peer review process?
• We want our patients to
receive exceptional care.
• We aspire to be lifelong
learners.
• During our long years of
training, we have learned
that experience-based
learning is the best kind.
• The people, payers and
regulators we serve expect
us to do it.
• The Joint Commission
requires us to do it.1
1I
• After mastering the
information in this
presentation, you will be
able to
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hired a vocal physician critic as our internal Joint Commission consultant.
Give three reasons why exceptional
physicians participate in a peer
review process,
Identify three things that might
launch the peer review process.
Explain the purpose and intent of
the Joint Commission’s Focused
Professional Practice Evaluation
(FPPE) process. (This is the new
term for Peer Review.)
Design the key steps in your own
FPPE (Peer Review) process.
What is a Focused Professional
Practice Evaluation1 (FPPE)?
• Allows the medical staff to focus an
evaluation on a specific aspect of a
practitioner’s performance
• Used in two circumstances:
– Additional information or a period of
evaluation is needed to confirm
competence
– Questions arise during the course of the
Ongoing Professional Practice Evaluation
(OPPE)
1This
was formerly known as peer review.
What is the intent of a Focused
Professional Practice Evaluation (FPPE)?1
•
There are two categories of issues
that will trigger the FPPE process:
–
•
All new practitioners and all existing
practitioners who receive new privileges
must undergo this process. (There are no
•
All concerns that arise in the OPPE
process or any other “peer review” will
trigger this process.
•
exceptions.)
–
•
The components of the FPPE
process include (but are not limited
to):
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–
–
–
1The
Criteria for conducting performance
evaluations
Method for establishing the monitoring
plan specific to the requested privilege
Method to determining the duration of
performance monitoring
Circumstances under which monitoring by
an external source is required
Joint Commission Website
The duration of the FPPE process
need not be for 12 months.
A peer review process that is based
only on untoward outcomes will not
meet the intent of this standard.
The bottom line principles for the
FPPE process are:
–
–
–
The process must be defined
The process must be consistently
implemented as defined
All new privileges (new applicants
and new privileges for existing
applicants) must be reviewed in
accordance with the defined process
What triggers the SOMC Department of
Medicine FPPE (peer review) process?1
• Readmissions with related
diagnoses within 72 hours
• Unplanned transfers to the ICU
within 24 hours of admission
• Unexpected mortalities or adverse
outcomes
• Cases referred from Risk
Management
• Cases referred at the request of
other committees, physicians or staff
1Naturally
you will want to identify your own credible triggers.
What is the SOMC FPPE process for
performance issues?1
Something triggers a
review.
Nurse reviewer
summarizes the case.
Improvement plan
monitored. Improvement
documented.
Documentation filed.
Physician input obtained.
Peer review committee
screens the case.
Yes
Concern?
No
Opportunity identified.
Improvement plan
detailed.
1The
Yes
SOMC Peer Review Process, Revised, May 2008
Concern?
No
No further action is
needed. Documentation
is filed appropriately.
What natural barriers to effective peer review
must exceptional physicians overcome?
• We must be willing confront each
other.
• We must invite and accept constructive
feedback.
• We must pursue evidence-based,
protocol-driven medical practices.
• We must invest the necessary time,
energy and study.
• We must acknowledge our own
shortcomings.
• We must modify our behaviors as a
result of what we learn.1
1I
received some critical feedback from a nursing aide about my patients’ satisfaction with the food.
In summary, what elements must be present to
create an effective peer review process?
•
•
•
•
•
•
•
•
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•
1The
A sustained organizational commitment
One or more physician champions
A simple, understandable process
A respected, detail-oriented infrastructure
expert
A fair, consistent, transparent process.
A passionate commitment to not waste
physicians’ time
An appeals process that makes sense
Strong protection from discovery and
liability1
An ongoing professional practice evaluation
process (OPPE) that is fair and transparent
Good food
Ohio statutes are among the strongest in the nation.
Where can you learn more?1
•
•
•
•
1Please
Learn more about The Joint Commission’s Focused Professional
Practice Evaluation (FPPE) at
http://www.jointcommission.org/AccreditationPrograms/Hospitals/Stand
ards/09_FAQs/MS/Focused_Professional_Practice.htm.
Learn more about The Joint Commission’s Ongoing Professional
Practice Evaluation (OPPE) at
http://www.jointcommission.org/AccreditationPrograms/CriticalAccessH
ospitals/Standards/09_FAQs/MS/Ongoing_Professional_Practice_Evalua
tion.htm.
Review a helpful overview from The Greeley Company at
http://www.greeley.com/pdf/TGC-MC57458_PeerReview-0607.pdf.
Read the interesting Wikipedia entry on Medical Peer Review at
http://en.wikipedia.org/wiki/Medical_peer_review.
visit www.KendallLStewartMD.com to download related white papers and presentations.
How can you contact me?1
Kendall L. Stewart, M.D.
VPMA and Chief Medical Officer
Southern Ohio Medical Center
President & CEO
The SOMC Medical Care Foundation, Inc.
1805 27th Street
Waller Building
Suite B01
Portsmouth, Ohio 45662
740.356.8153
StewartK@somc.org
KendallLStewartMD@yahoo.com
www.somc.org
www.KendallLStewartMD.com
1Speaking
and consultation fees benefit the SOMC Endowment Fund.
Are there other questions?
www.somc.org
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