• Thorough Preparation: Gather all relevant information for your peer review calls, including medical records, and ensure all participants are prepared.
  • Clear Objectives: Define specific goals for the call to keep the discussion focused and productive.
  • Effective Communication: Encourage active listening, use open-ended questions, and maintain a respectful tone.
  • Documentation and Follow-Up: Document discussions and decisions, follow up promptly, and evaluate and improve the process.

Peer review calls are a critical component of the healthcare payer organization’s quality assurance process. These calls allow professionals to discuss and evaluate the medical necessity, appropriateness, and quality of care provided to patients. To ensure these calls are productive and effective, it’s essential to follow a structured approach. Here are seven steps to maximize effectiveness during peer review calls.peer review calls

Challenges Faced on Peer Review Calls 

While peer review calls are essential for ensuring the quality and appropriateness of care provided to patients, they can also present several challenges. Being aware of these challenges can help healthcare payer organizations prepare and address them effectively. Here are some common challenges faced on peer review calls:

  1. Time Constraints: Peer review calls are often scheduled for a specific duration, which can limit the depth of discussion and decision-making. Ensuring that all relevant information is prepared and discussed efficiently is crucial in overcoming this challenge.
  2. Complex Cases: Some cases discussed during peer review calls may be highly complex, requiring in-depth analysis and discussion. Facilitating effective communication among participants and ensuring that all perspectives are considered can help address this challenge.
  3. Differing Opinions: Participants on peer review calls may have differing opinions on the medical necessity or appropriateness of care. Encouraging open dialogue and respecting diverse viewpoints can help navigate these differences and reach consensus.
  4. Technical Difficulties: Technical issues such as poor audio quality or connectivity problems can disrupt peer review calls. Having backup communication methods and technical support available can help mitigate these challenges.
  5. Confidentiality Concerns: Discussing patient information during peer review calls requires careful attention to privacy and confidentiality regulations. Ensuring that all participants are aware of and comply with these regulations is essential.
  6. Follow-up and Implementation: Ensuring that action items identified during peer review calls are followed up on and implemented can be challenging. Establishing clear accountability and follow-up processes can help address this challenge.

Step 1: Prepare Thoroughly 

Effective preparation is key to a successful peer review call. Before the call, gather all relevant information, including medical records, treatment plans, and any other documentation. Ensure all participants have access to this information to facilitate a meaningful discussion. Consider using a structured template to organize the information and facilitate discussion.

Best Practices:

  • Gather all relevant information, including medical records and treatment plans, before the call.
  • Ensure all participants have access to the information to facilitate discussion.
  • Use a structured template to organize information and keep the discussion focused.

Step 2: Set Clear Objectives 

Each peer review call should have clear objectives to guide the discussion. These objectives could include reviewing a specific case, discussing a complex claim, or evaluating the effectiveness of a treatment plan. Setting clear objectives helps keep the call focused and ensures that all participants are working towards a common goal.

Best Practices:

  • Define specific goals for the call and share them with all participants beforehand.
  • Keep the objectives focused and achievable within the time frame of the call.
  • Use the objectives to guide the discussion and keep it on track.

Step 3: Establish an Agenda 

Creating an agenda for the peer review call helps structure the discussion and ensures that all relevant topics are covered. The agenda should include a list of topics to be discussed, the estimated time for each topic, and any documents or materials that need to be reviewed during the call. Distribute the agenda to all participants before the call to allow them to prepare accordingly.

Best Practices:

  • Create a detailed agenda outlining topics, timeframes, and materials needed.
  • Distribute the agenda to all participants in advance to allow for preparation.
  • Use the agenda to keep the discussion focused and ensure all topics are covered.

Step 4: Facilitate Effective Communication

Effective communication is essential during peer review calls. Encourage all participants to actively listen to each other and ask clarifying questions when needed. Create a respectful environment where all opinions are valued, and ensure that everyone has the opportunity to contribute to the discussion.

Best Practices:

  • Encourage active listening among participants.
  • Use open-ended questions to encourage discussion and collaboration.
  • Maintain a respectful and professional tone throughout the call.

Step 5: Document Discussions and Decisions

 Documenting all discussions and decisions made during the peer review call is crucial for accountability and follow-up. Assign someone to take notes during the call, or use a recording device with the participants’ consent. After the call, distribute meeting minutes and any action items to all participants to ensure that everyone is on the same page.

Best Practices:

  • Assign a note-taker to document key points, decisions, and action items.
  • Share meeting minutes and action items with all participants after the call.
  • Ensure all documentation complies with privacy and confidentiality regulations.

Step 6: Follow Up Promptly

Following up promptly after the peer review call is essential to ensure that any action items are addressed in a timely manner. Send out meeting minutes, action items, and any additional information discussed during the call as soon as possible. This helps keep the momentum going and ensures that progress is made towards the objectives set during the call.

Best Practices:

  • Send meeting minutes and action items promptly after the call.
  • Set deadlines for action items and follow up to ensure completion.
  • Schedule a follow-up call or meeting if necessary to address any outstanding issues.

Step 7: Evaluate and Improve

 After each peer review call, take the time to evaluate its effectiveness and identify areas for improvement. Consider sending out feedback surveys to participants to gather their input on how the call could be improved. Use this feedback to make adjustments to the format, structure, or content of future peer review calls to enhance their effectiveness.

Best Practices:

  • Conduct a post-call evaluation to assess the effectiveness of the call.
  • Solicit feedback from participants on how the call could be improved.
  • Use feedback to make adjustments to future peer review calls to enhance their effectiveness.

Enhancing Peer Review Calls for Improved Healthcare Quality

Following these seven steps can help maximize the effectiveness of peer review calls in healthcare payer organizations. 

Partner With BHM To Streamline Your Peer Review Process