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
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.