Peer Review

WHAT IS PEER REVIEW?

Veterinary medicine maintains a very high degree of public and professional credibility. The people who have been involved with peer review feel that the “Peer Review System” is one of the best ways to demonstrate the real depth of veterinary medicine’s commitment to true service for our patients and the public.

Peer review, in its simplest terms, is a system by which the veterinary profession demonstrates the appropriateness and quality of the care it renders. It provides an expert and credible system for resolving disagreements that cannot be resolved at an earlier, more informal stage. It is expert because men and women with appropriate professional credentials help conduct the hearings, review the evidence and make objective decisions based on the findings. It is credible because its rules and procedures are clearly set forth and afford an equal opportunity for each participant to be heard fully.

PEER REVIEW IS NOT A COURT OF LAW

It is there to help educate, to settle problems, clarify and make corrections where necessary. It is VOLUNTARY for all parties concerned. In any case, those using its services should abide by its findings. The strength of peer review is derived from its ability to function effectively and fairly. The most vital element is sound judgment based on wide experience and exercised by men and women of honesty and good judgment.

PURPOSE

A peer review committee is established within a local, regional, or state veterinary association to review matters concerning but not limited to appropriateness of care and quality of treatment. Acting in an advisory capacity, it may also address fees. A committee may act on appropriate requests initiated by clients, veterinarians, or insurance carriers.

RESPONSIBILITY

It is the responsibility of a peer review committee to explore to the extent necessary all matters referred to it and to do so within a period of time that makes its efforts effective. Its means of communication may vary as the situation warrants. It holds hearings where necessary. A peer review committee has an equal responsibility to clients, veterinarians, and insurance carriers.

MATTERS FOR REVIEW

A. Appropriateness of Care: The peer review committee shall determine the professional acceptability of planned or completed treatments to include necessity and consistency with diagnosis.

B. Quality of Treatment: An evaluation of the skill with which a treatment is provided in light of the standards which generally prevail within the profession by those who routinely perform the treatment in question, as judged by competent practitioners who are qualified to perform the procedure.

C. Fees: The committee may determine from the evidence made available to it whether the fee in question is the veterinarian’s usual fee for a given procedure. If the fee being charged appears not to be the veterinarian’s usual fee, the committee then can determine whether the fee is reasonable considering the degree of difficulty or complexity of the veterinary procedure employed. The committee should not use a fee schedule or survey, or make any findings respecting what the customary fee in the geographic area may be for any particular procedure, since such activity could have antitrust implications.

When possible, it is best to have client and veterinarian work together to a satisfactory conclusion. However, by the time peer review is begun there is usually no doctor-client relationship to salvage, and many times these people cannot work together. It is certainly within the bounds of peer review for a committee to recommend refund of part or all of a fee, but NEVER more than the total fee.

LITIGATION

A case is considered formally in litigation when a party to a dispute files a complaint instituting a civil action in court. It is not within the scope of a peer review committee to consider cases in litigation. For those who choose to utilize the system, peer review is designed to resolve complaints or misunderstandings as an alternative so that civil action may be avoided.

Consequently, for a case to be eligible for consideration by a peer review committee, no party involved should have initiated formal litigation proceedings concerning any aspect of the veterinary services to be reviewed.

An exception to removal from peer review consideration of cases in litigation is the instance where the dispute between the veterinarian and client involves collection of a fee and the veterinarian has initiated litigation for collection. In such cases, the state peer review committee should have the discretion to determine whether peer review would be beneficial.

POSSIBLE RECOMMENDATIONS OF THE PEER REVIEW COMMITTEE

The recommendations should be fair and just for all parties involved and not what the committee thinks the parties would accept. The recommendations may range from:

1. No action being taken and fees paid

2. Full or partial refund of fees paid or owed

3. Continuing education in specific areas of study

4. Recommend a hospital inspection to the Veterinary Board of Examiners (this is recommended only if the committee feels the hospital facility contributed problems to the case being reviewed.)

5. Recommend that the client seek additional medical treatment for the patient. (Note: If the patient being reviewed requires further treatment this should not be administered by any of the doctors involved with the Peer Review case.)

METHOD FOR REQUESTING A REVIEW

Any party wishing to initiate review must make the request in writing to the appropriate local committee of TVMA. A request for review should be accompanied by supporting records and pertinent information, stating the specific questions to be answered.

A written complaint may be sent to:
Tennessee Veterinary Medical Association, Peer Review, PO Box 803, Fayetteville, TN 37334.

The permanent official peer review files will be maintained in the office of the Tennessee Veterinary Medical Association. The files will be confidential, with access only to the original letter of complaint and final letter of disposition of a specific case by a court subpoena.