Medical Care Law

Chapter 11 - Peer Review And Deselection

Highlights

Peer review is governed by state and federal law.

Federal law provides protections for peer reviewers if the process meets federal standards.

Improper peer review can result in civil and criminal liability.

Adverse peer review decisions must be reported to the National Practitioner Data Bank.

Physicians have few rights in managed care deselection procedures.

Introduction

Peer Review

Medical Staff Committees

The Legal Status of Medical Staff Committees

Legal Climate For Peer Review

State Law Violations

Federal Law Violations

Due Process Violations

The Federal Peer Review Law

Provisions of the Act

Protection from Liability

Standards for Professional Review Actions

Definition of Acceptable "Professional Review Action"

Limitations of the Act

Adequate Notice and Hearing

Notice of a Right to a Hearing

Notice of the Nature of the Hearing

Economic Competition

Rights in the Hearing

Rights at the Completion of the Hearing

Emergency Procedures

Duty of Hospitals To Obtain Information

Access to Information

Disclosure and Correction of Information

Confidentiality of Information

National Practitioner Data Bank

Reporting by Boards of Medical Examiners

Reporting by Health Care Entities

Form of Reporting

Protection for Persons Providing Information

Definitions and Reports (Sec. 11151)

Attorney's Fees

Good Faith Or Objective Standard?

Potential Adverse Impacts

The Problem of Bias

Conducting the Review

Documenting The Peer Review Process

Deselection

MCO Physician Market Strategy

Due Process and HCQIA

Public Policy Claims

References

Suggested Readings