EDITOR’S NOTE – January 29, 2019

The tightly regulated healthcare industry requires healthcare providers to routinely seek counsel of regulatory health law attorneys. Be it for subleasing an extra exam room, renting imaging devices, merging practices, adding a partner or addressing medical staff issues, health laws and regulations are always present in every aspect of the healthcare business. This publication aims to educate about and highlight different legal and regulatory aspects of the healthcare practice.

By  Reza Ghafoorian, M.D., Esq.

If there are health law topics about which you would like to read more, please do not hesitate to let us know. Please send your topic requests to rghafoorian@g2zlaw.com and we will try to cover them in our future issues.

Peer-Review: Five Important Considerations for the Medical Staff

Credentialing is serious business. Hospitals must constantly enforce their policies, assess risk and review standard of care to stave off liability and ensure quality of care. When a hospital determines that conduct of a staff physician rises to a risky level, it refers that member to peer-review for further investigation and corrective actions. However, a peer-review process can be unfair in the following five situations:

1. Competition Bias: When members of the peer-review committee compete in the same field of practice with the physician under review.
2. Management Bias: When the view of the medical staff and the hospital management is different with respect to “medical necessity of care.”
3. Narrow Specialty Disadvantage: When the peer-review committee members do not possess the experience and knowledge to review their specialized peer.
4. Violation of Clinical Autonomy: When the hospital management considers certain routinely performed procedures as having legal or compliance risk, and when physicians deem it necessary and effective.
5. Best Practice Bias: When there are two established, routinely practiced but conflicting practice protocols (e.g., neurosurgeons v. orthopedic spine surgeons) and hospital management elect the conflicting protocol as a standard of review.

Hospitals employ an army of attorneys and experts to assist them in implementing peer-review processes against staff physicians. It is important that staff physicians also seek competent counsel to assist them in navigating through the inherently bias and sometimes confusing hospital peer-review processes.