Case Study

From Inaccessible to Attainable: How Chartis Clinical Quality Solutions teamed with a Critical Access Hospital to Achieve Compliance and Improve Quality Through Ongoing External Case Review in Support of OPPE

3 minutes

The Client Challenge

A small, rural Critical Access Hospital (CAH) lacked the depth and breadth of a practitioner peer base to perform necessary, and recurring, Ongoing Professional Practice Evaluation (OPPE) reviews. After the organization’s leadership teamed with Chartis Clinical Quality Solutions (Chartis Clinical Quality) to review a few cases that arose out of quality concerns, they recognized the benefits of implementing a more formal and comprehensive ongoing external case review program.

OUTSOURCED ONGOING CASE REVIEW TRIGGERS
  • Lack of internal expertise and resources
  • Quality of care concerns
  • Reduce bias when only a small medical staff available
  • Reimbursement irregularities
  • Accreditation requirement
  • Regulatory compliance

The Solution

In close collaboration with the CAH’s quality leader, Chartis Clinical Quality developed a Master Services Agreement that outlined the scope of ongoing case review in support of OPPE needs. This also included multiple quality reviews in support of Focused Professional Practice Evaluation (FPPE) needs. Chartis Clinical Quality’s independent, board-certified, actively practicing providers conducted objective practitioner care evaluations using criteria-based assessments. The case review team utilized an encrypted portal that fostered collaboration and efficiency during the case review process. Each case review concluded with a concise, easy-to-interpret summary of findings that included scored observations and evaluations of quality and appropriateness of care, and in some cases, identification of quality or safety trends and opportunities for improvement. The CAH received a post-review consultation that clarified the findings and determined next steps.

Our Approach

MATCH

MATCH

Identify external peer reviewers from Chartis Clinical Quality’s extensive network of actively practicing and board-certified practitioners

EVALUATE

EVALUATE

Conduct independent review of records using proprietary evidence-based scoring methodology

SYNTHESIZE

SYNTHESIZE

Prepare comprehensive report, including a concise summary of findings

GUIDE

GUIDE

Provide post-review debrief and guidance for next steps

Client Impact

As part of the CAH’s peer review oversight plan for medical staff, outsourcing ongoing peer review cases to meet OPPE accreditation requirements provided an efficient and objective method for improving the reliability and consistency of the quality and safety of care provided. The ongoing case review program served as a roadmap for the outsourced function that also relieved the organization of significant time and resources associated with finding local practitioners to perform the reviews.

Outsourced ongoing case review efficiently met OPPE and FPPE requirements and improved quality of care.
50

Cases reviews annually

3- 4

Weeks time to completion

78

Performance improvement opportunities identified


How We Are Making Healthcare Better

Outsourcing your ongoing peer review cases that support OPPE efficiently provides organizations with recurring and reliable review of medical records in order to evaluate quality, safety, and/or appropriateness of practitioner care. This also supports accreditation and regulatory requirements. ”

Sheri Winsper, RN, MSN, MSHA
Vice President, External Peer Review/Clinical Quality & High Reliability, Chartis Clinical Quality Solutions

Key Takeaways

Outsourced ongoing case review can be achieved by:
  • Teaming with external peer review experts
  • Employing a proven, evidence-based peer review methodology and approach
  • Collaborating in real time through a secure portal
  • Scoring findings, identifying trends and improvement opportunities
  • Utilizing post-review support

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