Friday, September 25, 2015

Peer Record Review
updated 2017
keywords:  peer record review, supervision of an L.Ac., quality assurance measures, licensed independent practitioner (LIP), Joint Commission, credentialing, privileging, focused and ongoing professional practice evaluation (FPPE and OPPE), professional standards, quality assurance, quality improvement (QI)

Peer Record Review and Joint Commission
Peer review process is a usual professional standard required by The Joint Commission (formerly JCAHO or Joint Accreditation Commission of Hospital Organizations). 

Peer Review process and Provider vs. Technician status
Peer Review process is a standard that goes back to quality assurance.  Credentialing is a vetting process and a quality assurance tool.  Maintaining credentialing relates back to quality assurance.  

A provider who is not credentialed is a technician.  A technician does not get credit for the workload he or she generates.  Instead the technician’s supervisor gets the credit.  I believe this goes with the idea that the supervisor takes the responsibility for the work and hence garners the credit for the work.  

Peer Record Review and the East Asian Medicine Practitioner (EAMP)/Acupuncturist (L.Ac.)
In our profession, as East Asian Medicine Practitioners/Licensed Acupuncturists (acupuncturists), we are responsible for our own work (master’s level training, national board certification), and have LIP status (as defined by TJC) in most states, and so, when working in hospitals, we are providers (LIP-type provider), not technicians.  And, as LIPs, are credentialed and granted a delineation of privileges.  As part of being a credentialed provider, we participate in peer record review.  Peer record review is a periodic review of a practitioner's charting, reviewed by a peer in that provider's discipline.  For example, a licensed acupuncturist (LAc) quarterly reviews another licensed acupuncturist's chart records, following the facility's standard form.  This goal of this review, part of FPPE or OPPE, is a quality assurance check for gross lack of charting, improper charting or patient care.  The goal of FPPE and OPPE is to flag providers who are performing below standard.

Peer Review and SOAP Note Standard
Our profession has SOAP note standards.  When we do Peer Record Review, we are able to do so using our standard.  The standard has been general and based on TCM, as per national certification standard guidelines (NCCAOM board exam).  For more specific guidelines and training on proper SOAP noting and how this relates to our modern health care delivery system, see the upcoming Coding and Charting Manual/Handbook Resource and related blog.

Hospital Practice and Standards
Peer record review (which, at its core, follows a general profession-specific standard for charting) is an essential quality assurance measure for hospitals.  This is part of the quality assurance measures that make the facilities eligible to renew their Joint Commission accreditation.

The ability to participate in peer record review, a component of focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE), is also an essential delineation between providers who must be credentialed and those who practice as technicians.  A professional health care practitioner, such as an EAMP/LAc, participates in peer record review. 

Peer Record Review and need for minimum of  two EAMPs/L.Ac.s per facility
As licensed independent practitioners (LIPs), acupuncturists participate in a peer record review process.  Peer record review process is best accomplished in a timely manner when a minimum of 2 LAcs work within the same medical center (that uses the same electronic charting system, etc). Peer record review is done between two professionals who have the same specialty training (i.e.ACAOM-accredited master's or doctorate level education, passed the NCCAOM board exam).

An acupuncturist (LAc) is an LIP who signs his/her own notes.  An acupuncturist is a provider who refers to and consults with appropriate providers as needed.  An LIP requires only administrative supervision.  No practice supervision required. In a medical system, all providers work as part of a larger team. An acupuncturist, like other professional-level health care practitioners, participates in peer record review, a quality assurance process, with another acupuncturist (LAc), ideally within the same medical center. 

Similar LIP profession types who typically participate in peer record review as part of OPPE in hospital-based practice include physical therapists, health psychologists, and licensed clinical social workers.

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