Hospitals Supply of Medical Services

Lack of physician peer review

The Running a Hospital blog notes that a physician peer review system is absent in most hospitals.  Physicians are only critiqued when something goes wrong.  However, this need not be the case.

Our Chief of Neurology, Clif Saper, originated a thoughtful practice… The doctors in his department do randomly assigned reviews of the case notes of their colleagues, with an eye towards deciding if the process and diagnosis and treatment seem warranted by the facts of the case. Those reviews, blinded by reviewer, are then shared with the attending physician. The idea is a good one, to help all of the doctors do a better job by allowing an objective review of real cases. It is specifically designed not to be threatening, though, and the results are not made public, even within the department.

Why aren’t there supervisory physicians evaluating the work of attending physicians?  Paul Levy says “no place can afford to have dozens of senior physicians standing around judging the performance of dozens of attending physicians.”

Why not?  The reason is that most hospitals are paid not on quality but on a DRG or procedural basis. Hospitals do not get extra compensation for doing a good job, so their incentive to improve quality is small.  If the patient can easily observe hospital quality and the hospital can gain market share by providing higher quality, then it may be in the hospitals best interest to hire a supervisory physician.  It is more likely, however, that patients view hospital quality as a function of the reputation of the doctor, whether or not the hospital uses the newest technology equipment, and how the building looks.  These three items may or may not be directly related to hospital quality.

When quality of care is difficult for patients to observe, Paul Levy is correct in that it does not pay to hire supervisory physicians.