tci Medicare Compliance & Reimbursement - 2010 Issue 4

QUALITY ASSURANCE : Does Your Hospital's Peer Review Program Catch Unnecessary Surgeries and Procedures?

Revamping this safety net protects patients and the hospital's reputation and compliance record. Hospitals can sidestep a major patient safety and compliance nightmare: A physician who's been doing procedures that clearly don't meet established medical necessity criteria. That scenario occurred recently at a Baltimore,Maryland hospital where a surgeon stands accused of planting stents in people who didn't need them (see the cover story in the last issue of Medicare Compliance & Reimbursement, Vol. 33, No. 1). "In terms of surgical procedures, the No. 1 safety measure [to help prevent unnecessary procedures] is peer review in hospitals," says...

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