External Peer Review
Improve Practitioner Performance through Expert, Impartial Peer Review
Lack of expertise, conflicts of interest, politically sensitive situations, long-held loyalties—all challenges healthcare providers often face in executing an effective peer review process. We leverage an extensive bench of over 350 trained, independent, board-certified, actively practicing providers, resulting in timely, unbiased, third-party performance evaluation across all medical specialties.
Our External Peer Review Capabilities
Physician/Advanced Practice Professional External Peer Review
We provide objective, evidence-based practitioner care evaluations that help our healthcare clients deliver high-quality, reliably safe care to patients. Our board-certified, actively practicing reviewers bring best-in-class specialty expertise matched to meet both single case or multi-case external reviews.
In addition to traditional case review, we also offer:
- Expanded External Peer Reviews: We can provide expanded reviews that include identifying patterns and trends via quality measure data analysis, and/or integrated information from confidential interviews.
- Focused Professional Practice Evaluation (FPPE) Reviews: We provide case review to support appointments and initial privileging prior to exercising privileges.
- Proctoring Services: Onsite or virtual, we can provide direct practitioner observation as a stand-alone service or part of a medical record review.
Ongoing Case Reviews in Support of OPPE/FPPE
We work with clients to support FPPE and Ongoing Professional Practice Evaluation (OPPE) requirements through the recurring and reliable review of randomly sampled medical records in order to evaluate quality, safety, and/or appropriateness of practitioner care.
Medical Necessity Reviews
We provide proactive and impartial reviews of cases to assess if the documentation supports patient diagnosis and treatment decisions. Expert reviews of medical necessity enhance an organization’s ability to improve the quality and effectiveness of patient care while eliminating unnecessary treatment, cost, and potential legal risk.
Our deep bench of resources enables us to accelerate reviews to meet your expedited needs.
Do you have what it takes to become one of our external peer reviewers?
To meet growing client demand, we are expanding our esteemed physician reviewer panel. We encourage you to become an expert physician reviewer today. Submit your CV for consideration.
Our Unique, Strategic Approach Delivers Results
Expertise
We match credible, board-certified, actively-practicing experts with all types and volumes of case review needs—individual medical necessity, as well as federally mandated IRO reviews.
Findings
We deliver professional, concise reports that include criteria-based ratings, definitive findings, clear measurement, and feedback on performance issues and identified performance-improvement opportunities.
Focus
We help select the number and types of cases to review to ensure adequate evaluation, sparing organizations unnecessary time and expense throughout the review process.
Support
We provide post-review support to clarify findings and determine next steps, and we will defend and support findings—to include expert witness testimony as necessary—if subsequent corrective action, fair hearing, or litigation ensues.
Clinical Quality & Safety Improvement
Through our extensive expertise in clinical quality and high reliability, and peer review consulting services, we provide identification of trends and patterns leading to improved quality and safety outcomes for individual providers and/or complete clinical service lines.
Related Insights
Meet Our External Peer Review Leaders
Mary Hoppa, MD, MBA
Mary Hoppa, MD, is the Vice President of Bylaws and Governance with Chartis Clinical Quality Solutions. She also oversees the peer review practice and brings more than 25 years of consulting and healthcare experience to the firm.
Raúl Zambrano, MS, MD, FAAFP, FACHE, MRO
Dr. Raúl Zambrano is a Senior Physician Consultant and Clinical Education Leader with Chartis Clinical Quality Solutions. He brings more than 19 years of consulting and healthcare experience to the firm, particularly in the areas of credentialing, medical staff relations, hospital operations, quality improvement, coaching, and telehealth.
Andrew Resnick, MD
Andrew Resnick, MD, serves as a Director and the Chief Medical and Quality Officer, leading Clinical Quality, Safety, and High Reliability efforts in a role that spans both Chartis Consulting and Chartis Clinical Quality Solutions.
Christian Dankers, MD
Christian Dankers, MD, serves as an Associate Chief Medical and Quality Officer at Chartis, where he is focused on the expansion of clinical quality and high reliability care, bringing together capabilities across Chartis Consulting and Chartis Clinical Quality Solutions.
Robin L. Jones
Robin L. Jones is the Director of External Peer Review Services with Chartis Clinical Quality Solutions and brings almost 35 years of client relationship management experience within the professional services industry.
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