Doctors and Peer Review: 10 Things Entrepreneur Physicians Should Know

In the challenging world of protecting confidential information and meeting the seemingly endless list of health care regulations, don’t neglect your entity’s peer review regulatory compliance and your personal professional rights concerning peer review.  In the peer review area, HCQIA refers to the federal law Health Care Quality Improvement Act of 1986 (42 U.S.C. Section 11101 et seq.).  States, for example Iowa Code 147.135, also provide peer review regulations.  Here are 10 things entrepreneur physicians should know know about peer review.

1. Understand all applicable laws and regulations as well as case law
2. The purpose of peer review is to improve the quality of medical care
3. Liability protection is provided only if regulations are met for certain health care entities (see Sec. 11151) and certain actions (see Sec. 11112(a))
4. Liability protection does not provide immunity against civil rights actions (see Sec. 11111(a)(1)(D))
5. If you participate as a member of a peer review committee or board, execute a contract that specifies the health care entity will defend and indemnify you
6. State confidentiality protections are provided only if regulations are met and information is handled appropriately; mishandling can be damaging
7. Documenting and following peer review policies and procedures is critical
8. Remove yourself from peer review meetings and votes if you are a direct competitor of the physician subject to peer review (see Sec. 11112(b)(3)(A))
9. Specific notice and hearing policies and procedures must be followed (see Sec.  11112(b))
10. HCQIA requires entity reporting to the National Practitioner Data Bank (Entities making medical malpractice payments (see Sec. 11131), Boards of Medical Examiners that issue sanctions (see Sec. 11132), and entities that take review actions that adversely affect clinical privileges for longer than 30 days or physician accepts surrender of privileges under certain conditions (see Sec. 11113)

For more articles and topics like this, continue to follow the Health Lawyer on Your Side blog or contact the Goosmann Law Firm with any questions or concerns.

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