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Can a Mid-level Provider complete Peer Reviews on a Physician?
Peer review is the process used to evaluate performance and quality of care, as well as mitigate risk. Peer review must be completed for all services in the health center’s scope of project and must be completed between Providers within the same specialty who are similarly credentialed; therefore, it is not appropriate for a Mid-level Provider to complete peer review on a Physician, as the scope of licensure varies, especially from state to state. Likewise, it is not appropriate for a Provider in one specialty to peer review a Provider from another. Although there is some crossover between specialties, such as Family Practice and Pediatrics, the criteria to review an OB/GYN Provider is very different from that used to evaluate an Internal Medicine Provider. For this reason, health centers should develop peer review tools that are appropriate for the specialty being evaluated.
The standards for peer review are outlined in Chapter Five, Clinical Staffing (Chapter Five) and Chapter Ten, Quality Improvement/Assurance (Chapter Ten) of the HRSA Compliance Manual. Chapter Five discusses the need to consider the results of peer review/performance improvement activities in the reappointment process for credentialing, privileging and reappointment, while Chapter Ten discusses the need for the completion of quarterly QI assessments.