Healthcare Credentialing | symplr Blog

How to Make “Peer Pressure” Work for You

Written by Brian Betner | Dec 9, 2015 4:30:00 PM

Why is it that “peer review” sometimes seems like a four letter word? I’ve spent a good deal of time trying to figure out the answer to this question and have found that removing that stigma is a challenge for all organized healthcare providers.

First, let’s get on the same page

Peer review does have a specific legal meaning in most states because of state statutes, but by and large we’re talking about all quality review activities. Keep in mind: in healthcare today, peer review is just one piece of the puzzle with the ultimate goal to have a functional and efficiently whole. And we all want a lot of things:

  • A healthcare delivery system that is collaborative and coordinated in the interest of the entire organization and its community
  • Seamless access and use of credentialing privileging in quality data
  • Quality-oriented care
  • And we want to it in a patient-centric environment

 So, why is there a stigma with peer review?

We all recognize that peer review is the source of anxiety at so many organizations. And there are all sorts of reasons why there’s a stigma – in some cases, it’s angst in receiving constructive criticism and in other cases there are organizational culture issues (ie: the perception that the nature of quality oversight activities are that they will always be negative). Another reason is individual personality traits and a traditional mindset among some medical staff leadership around having limited solutions. Sometimes there is even a lack of internal expertise that a lot of organizations are ill-equipped to deal with.

The time to overcome that stigma is now

No matter the reason, we need to stop viewing peer review as a ministerial process required by law or accreditation requirements. The concept of evidence-based medicine and innovation and price transparency and clinical integration is everywhere. It is one of the reasons why you’ve seen so much media coverage of the healthcare industry the past few years. We also have a host of national trends that are affecting the way we deliver healthcare like The Joint Commission’s national patient safety goals or the depletion of Medicare trust fund – and this all contributes to an increased emphasis on the quality of care and a dominant consumer focus on value.

Providers will be or are being forced to improve and maintain quality in efficiency for business purposes, not just for patient care. As we look at such a significant percentage of reimbursement and at risk to quality and efficiency performance, quality has a significant role in the future of healthcare.

Effective peer review doesn’t necessarily provide greater access to healthcare to individuals but a more effective peer review program that removes the stigma and gets constructive participation by all involved to achieve the actual goals. And this can have a dramatic impact on the cost performance of an organization (and therefore its bottom-line financial performance associated with reimbursement and with patient engagement). Patients like to affiliate with organizations that they have optimal success with and that they feel they’re engaged with.

At the end of the day, the focus on quality, coordination, and value is here to stay. So, if the healthcare provider administration learned under a completely different paradigm – they need to get education really quick, because there is no silver bullet or single policy you can buy to magically fix everything. It comes down to three areas: buy-in of providers for cultural and structural soundness, education for physician quality champions, and attitude and transparency around the process.