Physician Peer Review1,2,3 A Practical Approach to the Focused Professional Practice Evaluation (FPPE) Process A Presentation for Pomerene Hospital Physician Leaders

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Physician Peer Review1,2,3A Practical Approach
to the Focused Professional Practice Evaluation
(FPPE) ProcessA 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. 2Im going to describe our
process as an example Im 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.
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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

• After mastering the information in this
  presentation, you will be able to
• 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
  Commissions 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.

1I hired a vocal physician critic as our internal
Joint Commission consultant.
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What is a Focused Professional Practice
Evaluation1 (FPPE)?

• Allows the medical staff to focus an evaluation
  on a specific aspect of a practitioners
  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.
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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 exceptions.)
• All concerns that arise in the OPPE process or
  any other peer review will trigger this
  process.
• The components of the FPPE process include (but
  are not limited to)
• 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

• 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

1The Joint Commission Website
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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.
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What is the SOMC FPPE process for performance
issues?1
Something triggers a review.
Nurse reviewer summarizes the case.
Peer review committee screens the case.
Concern?
Yes
Physician input obtained.
Improvement plan monitored. Improvement
documented. Documentation filed.
No
Concern?
Yes
Opportunity identified. Improvement plan detailed.
No further action is needed. Documentation is
filed appropriately.
No
1The SOMC Peer Review Process, Revised, May 2008
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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.
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In summary, what elements must be present to
create an effective peer review process?

• 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

1The Ohio statutes are among the strongest in the
nation.
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Where can you learn more?1

• Learn more about The Joint Commissions Focused
  Professional Practice Evaluation (FPPE) at
  http//www.jointcommission.org/AccreditationProgra
  ms/Hospitals/Standards/09_FAQs/MS/Focused_Professi
  onal_Practice.htm.
• Learn more about The Joint Commissions Ongoing
  Professional Practice Evaluation (OPPE) at
  http//www.jointcommission.org/AccreditationProgra
  ms/CriticalAccessHospitals/Standards/09_FAQs/MS/On
  going_Professional_Practice_Evaluation.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/Medica
  l_peer_review.

1Please visit www.KendallLStewartMD.com to
download related white papers and presentations.
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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_at_somc.org
KendallLStewartMD_at_yahoo.com www.somc.org www.Kend
allLStewartMD.com
1Speaking and consultation fees benefit the SOMC
Endowment Fund.
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Are there other questions?
www.somc.org
? Safety ? Quality ? Service ? Relationships ?
Performance ?