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Peer review of risk management cases, prior to a claim being filed, can be an opportunity for education and coaching on appropriate care.
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Published 10/1/2014
Walter G. Robinson, MD

Using Peer Review in Risk Management

How one practice involves physicians in managing liability risks

Here at Panorama Orthopedics & Spine Center in Denver, potential medical liability cases are everyone’s concern. That is due to the process we have developed for handling “risk management cases.”

Our 34-physician group supports a culture of mutual accountability and respect. About a year ago, as part of our risk management efforts, we implemented a process of “peer review” of cases that posed a potential liability risk. This process is not punitive, but it is designed to identify potential problems, analyze the issues, educate physicians on what to do, and develop teaching points that can help improve patient management.

Risk management cases are those in which an unexpected event occurs during the care of a patient. These are not necessarily errors or complications. Physicians are encouraged to report these cases whenever they feel uncomfortable with that unexpected event. This reporting assists the insurance company in resolving the issue on the physician’s behalf and could also help in possibly avoiding litigation.

Cases are reported to the Quality & Education Manager, who is a registered nurse. She then reports the details to the insurance company, thus providing advanced warning that an incident report may be forthcoming. We encourage physicians to contact the insurance company first, rather than turning to a personal attorney. This gives the insurance company an opportunity to work with us and the patient to address the issue.

A claim is an action triggered when the patient contacts an attorney and may result in a lawsuit. According to our insurer, COPIC Insurance Company, six out of seven risk management cases never become claims.

Care review
COPIC’s risk management director provides a list of risk management cases to our practice’s medical director. Cases are then passed on to the appropriate service line (sports medicine, spine, total joint, trauma, foot and ankle, hand and elbow, or orthopaedic medicine) within the practice. Physicians within the service line review the care to determine whether appropriate standards of care were met.

Cases are also reviewed by the Clinical Leadership Group (CLG), which consists of the medical director and a representative from each of the seven service lines. After the CLG review, the cases are then reviewed by the Colorado Orthopedic Risk Management group (CORM). This group consists of three different orthopaedic practices—Panorama Orthopedics & Spine Center, the Front Range Orthopedic Group in Longmont, and the Colorado Springs Orthopaedic Group. Each practice uses the same medical liability insurance carrier—COPIC—and works together to better manage risk and develop best practices within the orthopaedic specialty.

If the CORM deems that care in a particular case was “not appropriate,” the case comes back to the Peer Review Committee (composed of the medical director and the CLG representative from each of the seven service lines) for formal peer review. The treating physician also attends. The intent of this meeting is not to punish but to educate and coach the physician on appropriate care

Following this meeting, teaching points are developed and shared with all the physicians in the practice. Again, the goal is to educate physicians on appropriate care and provide them with resources to address any unexpected event or outcome.

In the past year, our peer-review process has dealt with several of these risk management cases. As understanding of the educational value of this process has increased, our physicians have become more comfortable with it, and interest in the program from other members of our risk management group has increased.

In the spirit of cooperation and education, further development of this peer review process within CORM will involve presenting the teaching points to members of the other practices in the risk management group. I believe that if we can standardize this process, it will add value to our attempts to manage risk to patients and ultimately improve patient care.

Walter G. Robinson, MD, is the medical director for Panorama Orthopedics & Spine Center. He can be reached at wrobinson@panoramaortho.com

Editor’s note: Articles labeled Orthopaedic Risk Manager (ORM) are presented by the Medical Liability Committee under the direction of Robert R. Slater Jr, MD, ORM editor. Articles are provided for general information and are not legal advice; for legal advice, consult a qualified professional. Email your comments to feedback-orm@aaos.org or contact this issue’s contributors directly.