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ICAHN External Peer Review Network

  • Need: Critical access hospitals (CAHs) in rural Illinois required an external mechanism for peer review.
  • Intervention: Using physicians from network member hospitals, a CAH network implemented a peer review process.
  • Results: Staff peer reviews also improved healthcare quality within the CAH network.


ICAHN logo In 2005, the Illinois Critical Access Hospital Network (ICAHN) CEO members identified a need for an external peer review process for physicians. The ICAHN staff and other selected individuals stepped forward to meet that need.

Starting first with a physician-led committee, a process inclusive of external review requirements was developed. Next, the peer review process was tested under pilot conditions. Six hospitals agreed to complete four reviews within a six-month interval. Physician volunteers tested the new processes and procedures. With completion of the pilot, participating physicians and hospitals were surveyed. In a decision guided by the pilot's success, the ICAHN board of directors approved the creation of an External Peer Review Network.

The network has three main goals: medical staff performance monitoring, quality improvement of medical care, and provision of alternative or additional review options. To serve as a reviewer, physicians are required to have one-year rural experience, medical staff status in good standing at an ICAHN hospital, and a hospital CEO recommendation along with a verified application.

Use of external reviews outside the network are necessary if peer network providers do not have appropriate clinical expertise, or if internal review findings are inconclusive, or there is a conflict of interest for available reviewers.

External Peer Review Network start-up costs were covered by 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 upon review completion. As of 2016, this rate increased to $75/review for routine review and $125/review for expedited reviews.

At start-up, special insurance coverage was also required for the peer review physicians. Originally purchased at an annual cost of $9,600, coverage is now provided under ICAHN's general professional liability umbrella policy. Today funding for the External Peer Review Network comes from both the review fees both for ICAHN member hospitals and hospitals outside of the state of Illinois.

Services offered

  • 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 practice areas: general/family medicine, advanced level practitioners, Certified Registered Nurse Anesthetists (CRNAs), surgery, internal medicine, radiology, obstetrics, emergency medicine, pediatrics, pain management, and orthopedics.
  • Accrediting and licensing organizations have expressed confidence in working with ICAHN's External Peer Review Network.


In 2014, 131 reviews were completed, followed by an increase of slightly more than 90 percent in 2015 with the completion of 250 reviews. In 2016, 233 reviews were completed. Primary service lines requested were surgery, internal medicine and family practice.


  • Gaining hospital and physician acceptance of outside reviews
  • Monitoring program integrity with intermittent outside review
  • Maintenance of a physician reviewer pool requires special credentialing and succession planning for retirements, unplanned absences or departures
  • Secure and timely transfer of review records between member hospitals
  • Specialty review requests have been occasionally declined due to reviewer limitations directly with that specialty, for example podiatry, ophthalmology and urology


  • Pre-enrollment estimates of hospitals and physician reviewers as minimum membership numbers are required
  • Specialized contractual agreements must be signed (HIPAA Business Associate Contract Addendum and the ICAHN External Peer Review Network Agreement) prior to program participation
  • Procedure for contested review: External Peer Review Network completes a second review at no additional cost
  • An initial offer of two free reviews is a key step in new member initiation
  • Consideration for the extra costs associated with out-of-state peer review requests, contracts and other legal fees for each state
  • Management of this service is provided by ICAHN staff as a value-added service for ICAHN members

Forms for Adaptation

Contact Information

Angie Charlet, Director of Quality & Education Services
Illinois Critical Access Hospital Network (ICAHN)

Critical Access Hospitals
Healthcare networks
Healthcare quality

States served
Illinois, Indiana, Michigan, New Mexico, Ohio

Date added
April 4, 2008

Date updated or reviewed
August 7, 2017

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.