Peer Review

A process in which a provider's clinical performance, decision-making, and outcomes are evaluated by other qualified providers in the same or similar specialty.

Peer review is how the medical profession self-regulates clinical quality. In hospitals, peer review committees examine cases where there were complications, unexpected outcomes, or complaints. The goal is to identify whether the care met accepted standards and to recommend improvements if it did not. For credentialing, peer review matters in two ways. First, your peer review history at hospitals where you have privileges is part of your credentialing file. Payers and hospitals ask whether you have ever been the subject of an adverse peer review action. If a peer review committee determined that your care fell below standards and the hospital took action against your privileges, that gets reported and payers will see it. Second, peer references are required for credentialing applications. Most payers and hospitals require references from two to three peers who can speak to your clinical competence. These should be licensed providers in the same or similar specialty who have directly observed your clinical work. Your old college roommate who happens to be a doctor but has never seen you practice does not count. Peer review proceedings are generally protected by state peer review statutes, which means the discussions and findings are confidential and cannot be discovered in malpractice litigation. This protection exists to encourage honest, candid review of clinical care without fear of legal consequences. If you are asked to participate on a peer review committee, take it seriously. It is a professional obligation and an opportunity to contribute to quality improvement. And if your own case comes up for peer review, respond professionally and provide the requested information. Most peer reviews are educational, not punitive. The committee is trying to improve care, not build a case against you.