COMMENTARY
Peer review in Texas BY ANDREA SCHWAB, JD, CPA The medical profession es-
tablished formal mechanisms for reviewing and evaluating the professional services provided by physicians more than a century ago. Physicians who join other physicians to judge their colleagues’ professional work do so to further an impor- tant process of self-regulation. Although the system assures physicians under review that they will have sympathetic understanding of their profes- sional problems, its primary function is to benefit the pub- lic by improving quality of care, promoting safety, and upholding medical standards. The purpose of medical peer review is “protection of an evaluative process, not mere records.”1
A physician’s involvement on a peer review committee often raises questions about his or her potential liability. Texas statutes and case law in- terpreting those statutes pro- vide guidance in determining the permissible scope of pro- fessional review activities and in predicting possible liability from the proper conduct of such activities. Ethical and legal principles also provide additional guidance. Medical peer review is the evaluation of medical and health
care services, including evaluation of the qualifications and professional conduct of professional health care practitioners and of patient care provided by those practitioners.2
Medical peer review committee The Texas Medical Practice Act provides protections to a “med- ical peer review committee” of a “health care entity.”5
It is imperative that a medical peer
review committee
adhere to its bylaws to obtain the full benefit of statutory immunity and privileges.
It can in-
clude evaluating the merits of a complaint regarding a practi- tioner, the accuracy of a diagnosis, the quality of care provided, or the qualifications of a practitioner.3 Federal and state laws encourage the peer review process
by providing limited immunities and privileges to peer review members and participants.4
nitions of these two terms are very important in determining whether the committee and individuals involved may obtain the protections provided in statute.
A health care entity is de- fined to include:
• A hospital; • An entity that provides or pays for medical care or health care services and fol- lows a formal peer review pro- cess to further quality medical care or health care;
• A professional society or association of physicians that follows a formal peer review process to further quality med- ical care or health care;
• An organization estab- lished by a professional society or association of physicians, hospitals, or both that col- lects and verifies information concerning the qualifications, competence, or performance
of licensed health care professionals; or
• A health care collaborative certified under Chapter 848, In- surance Code.6
A medical peer review committee is a committee, governing
board, or medical staff of a health care entity that operates under written bylaws and is authorized to evaluate the quality of medical and health care services or the competence of phy- sicians.7
It is imperative that a medical peer review committee
adhere to its bylaws to obtain the full benefit of statutory im- munity and privileges. Some question whether an accountable care organization
October 2011 TEXAS MEDICINE 59 The defi-
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