Know What Circumstances Require External Peer Review

External peer review providers help facilitate this process, connecting organizations in need of external peer review with peers who provide that service.

This article was first published July 26, 2021, by HCPro's Credentialing Resource Center, a sibling publication to HealthLeaders.

This is where external peer review providers come into play.

External peer review occurs when someone outside the organization completes the peer review. For example, a physician on the East Coast may review a case raising concern in a hospital on the West Coast.

Even though the two physicians have never met, they still may be considered peers in the sense that they have the same training and perform the same work.

External peer review providers help facilitate this process, connecting organizations in need of external peer review with peers who provide that service.

The peer review committee typically recommends external peer review to the medical executive committee (MEC) under the following circumstances:

• Litigation: When dealing with the potential for a lawsuit.
   
• Ambiguity: When dealing with vague or conflicting recommendations from internal reviewers or medical staff committees, and when conclusions from this review will directly affect a physician's membership or privileges.
   
• Lack of internal expertise: When no one on the medical staff has adequate expertise in the specialty under review, or when the only physicians with that expertise are determined to have a conflict of interest.
   
• New technology: When a medical staff member requests permission to use new technology or to perform a procedure new to the hospital and the medical staff do not have the necessary subject matter expertise to evaluate adequately the quality of care involved.
   
• Miscellaneous issues: When the medical staff need an expert witness for a fair hearing, for evaluation of a credential file, or for assistance in developing a benchmark for quality monitoring. In addition, the MEC or governing board may require external peer review in any circumstances deemed appropriate by either of these bodies.