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 External Quality of Care Reviews for Provider Organizations
By: Skip Freedman


If your hospital or a medical group has doctors seeing patients on a regular basis, you need to perform quality management functions to determined and verify the proper quality of care. Traditionally organizations do this internally using their own nursing resources and physician peer panels.

Increasingly, companies are outsourcing this type of activity to an Independent Review Organization which can assign a specialist to look at specific cases and determine root cause analysis of any care deficiencies. This makes sense when the hospital or medical group has a shortage of specialist availability to look at cases that are complex and require a specific specialist to review a sentinel event. Outsourcing this function is becoming more common among leading medical organizations and hospitals.

We're working with the top three hospital chains in the country and they are increasingly viewing peer review as a non-core activity that can be cost effectively and easily outsourced. They understand that this makes sense, because they can get it done faster using and Independent Review Organization then they can internally. They also understand that when sentinel events occur, and their organization risks expensive lawsuits or sanctions, the cost of actually performing these external hospital peer reviews is miniscule in comparison. That?s why providers are looking more and more to outsource quality of care reviews to Independent Review Organizations like Allmed.

About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its independent medical review and hospital peer review services includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed Medical News Blog and the Independent Review Organization Blog.



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