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Peer Review

Utilization Review - Providers

Peer Review

URAC Accredited Independent Review Organization

Peer Review is used to make final judgements about quality of care in many quality assurance activities. To overcome the low reliability of Peer Review, input from several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability.
SFUR is a proven and affordable source of 3rd party medical Peer Reviews with fifteen years of history servicing hospitals, healthcare delivery systems and physicians nationwide. SFUR’s Board certified specialists will testify at fair hearing on request. SFUR is URAC Accredited Independent Review Organization which means client benefits from standards.
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OUR CURRENT PHYSICIAN SPECIALTIES

  • Anesthesia
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  • Pulmonology
  • Polysomnography Radiation Oncology
  • Radiation Oncology
  • Thoracic Surgery
  • Urology
  • Vascular Surgery

Example

The benefit is derived from SFUR because numerous organizations do not have a corresponding physician specialist to review a case with for the specialty in question. When this scenario occurs, SFUR delivers these reviews at a competitive price. The outcome is an SUR physician review that can be used by the facility’s medical executive committee to take action if needed on the performing physician in question.

When a Medical Executive Committee or a Quality Review Department needs a second opinion on a particular case, they can reach to SFUR’s physician panel.

A typical set of questions for  peer review would include:

Care by the Physician

Treatment was appropriate, medically necessary and met generally accepted performance standards including anticipation and prevention of, or identification and response to known complications.
Treatment was not appropriate, either all or in part
Treatment was not medically necessary.
Treatment was controversial, unproven, experimental or investigational.
Treatment was not timely or not performed in the proper sequence, including recognition of and response to known or anticipated complications
Response time and/or ongoing assessment, including that for unanticipated complications were not adequate

Peer Review Outcome

Treatment appropriate, outcome good and any adverse impact on the patient was minimal.
Treatment appropriate, but in spite of that the patient sustained significant adverse outcome.
Treatment inappropriate, but the adverse impact on the patient was minor or minimal temporary or permanent harm.
Treatment inappropriate and the patient sustained moderate to severe temporary or permanent harm.

Contributing Causes

Technique of the physician.
Judgment of the physician.
Failure by physician to comply with hospital/medical staff bylaws, rules and regulations.
Issues identified with providers of care other than the physician under review.
Hospital systems/process issues.
Inadequate documentation and/or interdisciplinary communication.
Contributing cause not identified.

Action to be considered

No remedial action recommended at this time.
Tracking and trending recommended.
Remedial action of some sort (ranging from FPPE to more formal corrective action) should be considered.