Case Studies
The Peer Review Process
In October 2005, Governor Arnold Schwarzenegger signed into law California Senate Bill 231, which, among other things, amended the California Business and Professions Code 800, including Section 805.2. Section 805.2 provided for a comprehensive study of the physician peer review process, as conducted by peer review bodies. Another equally important component of this study was to evaluate the continuing validity of Section 805 and Sections 809 to 809.8, inclusively, and their relevance to the conduct of peer review in California, since they play such a critical role in ensuring quality medical care. The number of 805 reports had decreased over the years, and both the public and the California legislature wondered about any possible inconsistencies in the process of peer review.
Lumetra Healthcare Solutions was selected as the independent entity to conduct this peer review study, based on our independent experience working with the peer review community.
The study, which was completed in the summer of 2008, was designed around the requirements of the 805.2 legislation, focused on four entities involved in peer review activities:
- Licensed healthcare facilities/clinics
- Healthcare service plans
- Professional societies
- Medical groups
The research was quantitative and qualitative, cross-sectional, retrospective, and descriptive. Multiple data collection methods were employed, including document review, surveys, focus groups, key informant interviews, and onsite visits.
One of the findings of the study is that the present peer review system is broken and in need of a major fix, if the process is to truly serve the citizens of California. The report cites the inconsistencies in the way entities conduct peer review, select and apply criteria (e.g., implicit vs. explicit review), and interpret the law regarding peer review reporting and hearings.
Bringing our impartial expertise to the study, the final report, which was issued in 2009, recommended a separate, independent peer review organization for California. We suggested that physicians, medical groups, and hospitals handle the initial investigations, but that an independent agency make the final decision.
