Elements of an Effective Case Review Process

Duration: 60 Minutes
Instructor: Mark A. Smith
Webinar Id: 800090


One Attendee


Case Review has historically and continues to be a main stay of performance evaluation. By its nature of individuals rating other individual's performance, it has always carried the burden of a degree of subjectivity. This has lead, in many cases, to a system described as punitive and unfair. In extreme cases, there are accusations of sham peer review that often fall into litigation. This talk will be composed of two parts.

The first and major section will discuss best practice steps in establishing a fair and effective case review process. These steps include case identification, triaging, summary of issues, initial review, response of involved practitioner and case adjudication. This will also go into roles and responsibilities of the various participants including reporting methods.

The second area will talk about the successful implementation of case review and some of the common pitfalls that may be avoided.

Why should you attend:
Hospital and Medical Staff leaders who oversee, conduct and/or support individual case review as part of the peer review process for evaluating practitioner performance. This also includes any Managed Care groups, Medical groups, Insurance Companies or other Payers that have established practitioner case review as part of their processes.

Areas Covered in the Session:

  • The Place of Case Review in Peer Review
  • Case Review Process
    • Case Identification
    • Case Summary
    • Initial Physician Review
    • Initial Committee Review
    • Input from Involved Practitioner
    • Final case adjudication by Committee
    • Reporting Case Review Results
  • Implementation of Case Review
    • Communication with Organization members
    • Choosing case review indicators
    • Typical pitfalls by reviewers in individual case review

Who Will Benefit:
  • Physicians, Dentists & Health Care Professionals
  • Quality Professionals
  • Medical Staff Service Professionals
  • Managed Care Group Administrators
  • Practice Management
  • Insurance Company Quality Managers
  • CEOs
  • Risk Managers
  • Compliance Officers
  • Board Members

Speaker Profile
Mark A. Smithis a consultant with HG Healthcare Consultants, a healthcare consulting firm. He brings 25 years of clinical practice and hospital management experiences to his work with physicians and hospitals across the United States.
Dr. Smith is a board-certified surgeon. He practices part time as a Clinical Assistant Professor of Surgery in the Vascular Surgery Section at the University of California Irvine Medical Center. He works as a Senior Consultant with Morrisey Associates Inc. He also is the Chief Medical Officer for Verisys Corporation. He had previously practiced General and Vascular Surgery in a private practice setting for 25 years. Dr. Smith's previous positions included president of the Medical Staff, chief of surgery, chairman of peer review committee, and medical director of cardiac surgery at Desert Regional Medical Center.

Dr. Smith is a graduate of Jefferson Medical College. He received his general surgery residency training at the University of Kansas Medical Center and had Cardiac and Vascular Surgery fellowships at the Hospital of the University of Pennsylvania. Dr. Smith holds an M.B.A. from the University of Phoenix. He enjoys tennis, traveling and is an avid private pilot.

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