| Peer review is used in many industries and in | | | | are not associated with the case in question, |
| scholarly publishing to decide whether an | | | | provide claims decisions for health insurance |
| individual´s experience, background, | | | | payers, workers compensation insurance payers |
| professional behavior and credentials provide | | | | and disability insurance payers. This kind of peer |
| sufficient qualifications to engage in an activity. | | | | review uses independent, unbiased doctors to look |
| The individuals conducting the review are the | | | | at medical cases of other doctors in order to |
| person´s peers, who have similar | | | | make an objective third-party decision about the |
| experience, backgrounds and credentials in the | | | | doctors´ actions, and in some cases, the |
| industry or field of study. They review the | | | | accountability of those actions. |
| individual´s qualifications and work product | | | | In another broader meaning, the term focuses on |
| and judge whether that individual is suitable for | | | | improving the delivery of services to patients in |
| the task. This type of review is a "credentialing | | | | hospitals by also examining the actions of doctors. |
| peer review." | | | | In this case, physician peer reviewers evaluate |
| Credentialing peer reviews have been used for | | | | the results of sentinel events in a hospital for |
| years in academia and science to review a | | | | quality assurance purposes. They investigate bad |
| candidate´s qualifications and publications. | | | | outcomes to determine if there was a |
| Other professions, such as accounting and finance | | | | misdiagnosis, maltreatment or any systematic |
| also use credentialing reviews. Likewise, hospitals | | | | problems leading to that event. These peer |
| and medical practices perform them before hiring | | | | reviews can lead to corrective actions that can |
| doctors. At AllMed, we conduct credentialing | | | | include hospital process changes or even sanctions |
| reviews to determine whether a doctor has the | | | | against doctors. |
| right to practice a particular specialty or procedure | | | | Unfortunately in the healthcare business |
| before bringing that physician specialist into our | | | | everybody uses their own vocabulary to talk |
| review panel. | | | | about the same thing. So today the terms peer |
| But there are multiple meanings of peer review in | | | | review, independent medical review, hospital peer |
| health care. Peer review can mean an | | | | review and medical peer review are used |
| "independent medical review," where doctors, who | | | | interchangeably. |