We still run across healthcare organizations wanting to build and maintain their own panel of physicians to perform medical peer reviews. This may have been a good practice in the distant past; however, current industry best practices suggest considering a more efficient approach.

Outsourcing has become a popular practice in the United States. This trend is based on solid benefits reduced cost, resource flexibility and core expertise. In the past, many healthcare organizations sought to own all the resources required to deliver their services and manage their business. Today, forward-thinking organizations are more likely to shed non-strategic, non-core pieces of their business, outsourcing them to specialty providers.

Lets explore the wisdom behind outsourcing internal medical peer reviews to an independent review organization (IRO). This is an especially important topic for organizations that have already invested in building a panel of physicians to assist with internal reviews.

First, there is the high cost of building and maintaining a panel of specialists who are independent, credentialed, licensed, in active practice and board certified. In some hospitals, there is only a single specialist on staff for a specific narrow practice area. Clearly this physician cannot serve on his or her own peer review committee. The process of building and maintaining a panel that can serve specialty practice areas is very costly especially if there is a small volume of cases to amortize the cost.

Second, the changing standards of care, along with new experimental and investigational treatments, impact patient care decision-making. With the rapid advancement in medical treatments and technology, it is very difficult for an in-house panel of physician specialists to keep up with the latest advancements in all areas of medicine. The best IROs are constantly recruiting and credentialing specialists who have cutting-edge knowledge that can be applied to improve the overall quality of medical reviews.

Third, there is the need to assure that medical reviews are completely independent and impartial. It is difficult to make this claim when the experts are all members of the organizations own panel. Using an outside provider assures an arms-length evaluation based on the cases facts without a hint of contamination from existing business, personal and professional relationships that might exist among members of the panel.

Finally, by using an IRO, healthcare organizations can easily expand or contract to meet the volume of peer reviews actually required. When reviews are done in-house, there are only two choices: plan for maximum capacity which is very expensive, or let the cases queue longer when demand is higher. The latter strategy becomes problematic if the organization is subject to specific state or federal deadlines.

When all of these elements are considered, its clear that many healthcare organizations are better served by outsourcing their medical reviews to an IRO. What about your organization? What does your process look like? Is it time to re-invent the way you conduct medical reviews?