What
Does “Peer Review” Have to Do with Me?
Adam Lighter, DDS
Chairman, QCDS Peer Review and Quality Assurance Committee
Most
NYSDA members never think about the Queens County Dental Society’s
Peer Review and Quality Assurance Committee. It is easy to forget
that it exists or ignore it until you receive a letter in the mail
with an Agreement to Submit to Peer Review requiring you to
respond to a patient’s complaint. Some members react in anger. Other
reactions are relief or resignation. All have questions. How could
that patient dare complain about my treatment? Is this process fair?
Should I just give the patient back some money? Am I in trouble?
The
most important things to remember are:
1. Peer Review is an impartial alternative complaint resolution
process.
2. You are not “in trouble”.
3. The process is fair, impartial and confidential.
As a
profession, dentistry has a responsibility to the public to provide
a quality assurance mechanism. NYSDA members are required to
participate in Peer Review as a condition of membership. This
demonstrates the commitment of professional association members to
quality care. Peer Review provides a timely, free and definitive
resolution to patient complaints about treatment. Unlike the courts
or the NYS Education Department’s disciplinary processes, Peer
Review decisions are based on an evaluation by a Committee of
impartial professional peers. It benefits both the public and the
profession.
Patients bring complaints for a number of reasons. They may be
dissatisfied with the outcome of their treatment. They may have had
poorly performed care, or they may have unrealistic expectations.
Others are told by a new dentist that previous treatment needs to be
redone. Peer Review can help protect the reputation of the previous
dentist or help a patient who has had poor treatment.
Peer
Review assures that the dentist will receive payment for properly
performed treatment. If the patient has an outstanding balance, that
amount must be placed in the Dental Society’s escrow account prior
to the Peer Review.
Peer
Review is a membership benefit only available to NYSDA members. If a
complaint includes a non-member partner, employer or employee of a
NYSDA member, the benefit is extended to that non-member to help
protect the member dentist. Assuring that your partners, employers
or employee dentists are NYSDA members helps ensure your access to
this important membership benefit.
The
three most common questions about Peer Review are:
1. What is the
outcome of a Peer Review?
2. Is it
confidential?
3. Can I still be
sued?
When
treatment is found to be acceptable by the Peer Review Committee,
the treating dentist maintains the patient fees. If the dentist does
not think the treatment will withstand an evaluation by professional
peers, the dentist may choose to offer a partial or full fee refund
during the mediation phase of the process. Once the case goes to a
hearing, three members of the Peer Review Committee individually
will examine the patient. If the Peer Review Committee finds that
the treatment does not meet acceptable standards of care, the
dentist is directed to refund the fees for the treatment. The Peer
Review Committee may also direct the dentist to complete specific
continuing education to help re-mediate any apparent deficiencies.
The maximum financial liability the dentist has in Peer Review is
the amount of the fees. Peer Review does not make arbitrary awards
for “pain and suffering” or punitive awards.
Peer
Review is an alternative dispute resolution process.
That is, if the complaint has been resolved through a legal action
or release from liability – or the matter is currently in
litigation, the subject of an OPD inquiry, or in collection – Peer
Review cannot proceed.
Peer
Review findings are not publicized or reported to the NYS Education
Department’s Office of Professional Discipline or the National
Practitioner Data Bank. However, if a dentist chooses to have a
liability carrier supply the patient refund, that carrier is
obligated to report the refund to these agencies.
Further, the Agreement to Submit to Peer Review includes
clauses wherein all parties (patients and dentists) agree to keep
the process confidential. In the Agreement contract, the
parties also agree not to bring a suit against the other party on
the same issues resolved by the Peer Review. The New York State
courts have upheld the process and the validity of the Agreement
to Submit to Peer Review.
Finally, either party may choose to be represented by an attorney;
however, there is no role for attorneys in the process. The hearing
is based on the committee’s evaluation of patient records and
individual examinations of the patient. There is no questioning by
the parties to the peer review – or an attorney - and no “cross
examination”.
If
you have any questions about Peer Review, please contact the Queens
County Dental Society for a copy of A Guide to Peer Review or
e-mail your question to Dr. Lighter at AWLDDS@yahoo.com.
Queens
County Dental Society | 86-90 188th St | Jamaica, NY 11423 | Tel:
718-454-8344
Home
|
Member Benefits
|
Upcoming Events
|
Bulletins
|
Leadership
|
Photo Gallery
Membership
App.
|
Classified Ads
|
GLIDM
|
Sponsors
||
Helpful Contacts
