ICAHN External Peer Review Network
- Need: Many Critical Access Hospitals (CAHs) in the rural areas of Illinois need an external mechanism for peer reviews.
- Intervention: A peer review process, implemented by a Critical Access Hospital network, uses physicians from other network member hospitals to complete peer reviews.
- Results: Improved the quality of healthcare for network member hospitals in the rural areas of Illinois by monitoring the performance of medical staff and identifying areas for improvement.
When CEOs who are members of the Illinois Critical Access Hospital Network (ICAHN) identified the need for an external peer review for physicians, the ICAHN staff and select individuals from member hospitals stepped forward in 2005 to form a committee and make it a reality. Rather than hire an outside consultant, the committee decided to create the peer review process internally. Fortunately a physician from one of the member hospitals served on this initial committee, helping to review documentation and develop a credentialing procedure.
Goals of ICAHN’s External Peer Review Network:
- Monitor medical staff performance
- Improve quality of care provided by medical staff
- Identify areas for improvement
- Provide an alternative or additional review option for hospitals
With a basic process developed, the committee implemented the pilot project. They secured the participation of six hospitals, with each hospital agreeing to complete four reviews during a six month period. Several physicians agreed to test the review processes and procedures by serving on the peer review panel. After the six month period ended, the panel physicians and the six initial participating hospitals were surveyed. Results were evaluated and the pilot was deemed a success. Recommendations were made by the committee to the ICAHN board of directors that ICAHN begin offering external peer review as a service.
Currently ICAHN has 62 hospitals from Illinois, Indiana, Michigan, New Mexico, and Ohio participating in the External Peer Review Network. Panel physicians need to have one year of rural provider experience, active medical staff status at an ICAHN member hospital, a recommendation letter from their hospital CEO, and a completed application with verification.
Securing an external review can be particularly useful to a hospital if internal peer reviewers do not have appropriate clinical expertise, internal review findings are inconclusive, and/or there is a conflict of interest for available reviewers.
Start-up costs for the External Peer Review Network were in-kind contributions of time by those serving on the committee and ICAHN staff. Other start-up costs included payment of $50/review paid to each panel physician each time they completed a review. This rate has increased to $75/reviewer as of 2016 for routine review and $125/reviewer for expedited reviews. Insurance needed to be purchased at an annual cost of $9,600 for medical malpractice for physicians.
Today funding for the External Peer Review Network comes from review fees both for ICAHN member hospitals and hospitals outside of the state of Illinois. ICAHN no longer needs to purchase a separate professional liability policy for the review panel because the panel can now be included under ICAHN’s general professional liability umbrella policy. Management of this service is provided by ICAHN staff because it is a value-added service for ICAHN members.
- Each ICAHN member hospital that participates in the program can have reviews completed for $175/review or $225/review for expedited service.
- Peer reviews for non-ICAHN member hospitals are $225/review. Due to the costs of mailing charts out-of-state, ICAHN does not offer an expedited review unless absolutely necessary.
- Reviews are available for the following areas: general/family practice, mid-level providers, Certified Registered Nurse Anesthetists (CRNAs), surgery, internal medicine, radiology, obstetrics, emergency department, pediatrics, pain management, and orthopedics.
- Accrediting and licensing organizations are comfortable working with ICAHN’s External Peer Review Network.
- ICAHN External Peer Review Network started generating a revenue of several thousand dollars in 2013.
- In 2014 the External Peer Review Network completed 131 reviews.
- In 2015, the External Peer Review Network completed 250 reviews.
- Getting hospitals and physicians comfortable with outside reviews was a challenge.
- Building the integrity of the program was important, so after it had been up and running for a while, ICAHN had it critiqued by an outside reviewer.
- Getting physician reviewers can be an obstacle because each needs to be credentialed, and then it is an ongoing recruitment process for more reviewers because of retirement and other reasons for departure.
- Getting records back and forth between ICAHN and member hospitals in a secure and timely member can be a challenge as methods of transferring information are constantly changing.
- Some review requests have been turned away due to limited provider reviewers in the areas of podiatry, ophthalmology and urology.
- Be sure member hospitals are going to participate and that there will be physicians willing to serve as reviewers.
- Hospitals must sign the HIPAA Business Associate Contract Addendum and the ICAHN External Peer Review Network Agreement prior to their participation in the external peer review process.
- If someone disagrees with an initial review, the External Peer Review Network completes a second review at no additional cost.
- It was important to initially offer two free reviews to member hospitals in order to get the service set up and get members using it. This is a key step in initiating members to the service.
- When setting up the out-of-state peer review services, plan for extra costs for contracts and other legal fees for each state added.
Forms for Adaptation
Angie Charlet, Director of Quality & Education Services
Illinois Critical Access Hospital Network (ICAHN)
Critical Access Hospitals
Illinois, Indiana, Michigan, New Mexico, Ohio
April 4, 2008
March 28, 2016
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.