Peer Review for Behavioral Health Providers

Should peer reviews for Behavioral Health providers be of the same discipline or higher?

The process of peer review involves a systematic review of the quality and utilization of healthcare services provided by clinical staff. Peer review is utilized to evaluate performance, assess the appropriateness of care and mitigate potential risks.  Peer review must be completed for all services in the health center’s scope of project, as well as between providers within the same specialty who are similarly credentialed.  

Same-discipline peer review is completed by a peer or colleague who works in the same clinical discipline and has a similar scope of practice.  For example, a primary care physician is reviewed by another primary care physician, or a nurse practitioner is reviewed by another nurse practitioner. This type of peer review encourages a collaborative and supportive environment.  

Higher-discipline peer review is completed by a provider who has a broader or more advanced scope of practice. For example, a nurse practitioner is reviewed by a physician, or a physician is reviewed by a medical director with a higher level of training or authority.

Regardless of the specialty, it is not suitable for a mid-level provider to complete peer review on a physician, as the scope of licensure and practice varies. Similarly, it is not appropriate for a provider in one specialty to peer review a provider from another.  

The Health Resources and Services Administration (HRSA) Health Center Program Requirements do not dictate whether same-discipline or higher-discipline peer review is expected, although industry standard best practice supports a balanced combination in order to evaluate performance and facilitate professional growth and collaboration. 

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 Health Center Program 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. 

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