Seven tips for responding to a peer review letter

There are multiple avenues in which a case can be referred to the Professional Practice Evaluation Committee (PPEC), our Peer Review Committee. This includes physician referral, Safety Net System, Risk Management, among others.

Once a case is received, the PPEC Chair will review the case and determine if it is appropriate for PPEC or needs to be referred elsewhere. For example, only cases that occur within the hospital are referred to PPEC. Cases that occur outside the hospital are sent to the Medical Group.

Once it is determined that the case is appropriate for PPEC, a PPEC committee member with the most expertise is assigned the case for review. If no member has expertise or there is a conflict of interest, the case is sent for either internal peer review (a member of the Medical Staff) or external peer review.

The case is then presented to the PPEC and one of two pathways is taken. Either the case is determined to be “care appropriate” and a letter is sent to the provider that a case was reviewed and determined to be so, closing the case. Alternatively, it can be determined by PPEC that more information is needed and a letter with specific questions is sent to the provider. PPEC recognizes the medical record often does not contain all the information needed to evaluate care in a complex case.

As a valuable member of the care team, a provider’s insight and perspective will assist in fully understanding decision-making and the care provided to the patient. This is the provider’s opportunity to share his or her perspective on the case and explain the thought process. The expectation is that the letter be answered within 14 days of receipt. At the following PPEC meeting, the case is reviewed again with the provider’s response and a final determination on the case is made.

There are three options for final determination:

• care appropriate

• minor improvement opportunity

• significant improvement opportunity

For minor improvement and most major improvement opportunities, these are tracked and trended. In rare cases, when there is significant concern for patient safety, the case is referred to MEC for further action. 

Responding to a peer review letter request as a physician or healthcare provider requires a thoughtful, detailed, and professional approach. 

Tips to consider when responding to a peer review letter:

1. Understand and carefully read the request. Thoroughly review the letter to understand the specific issues or concerns being raised. Identify any data or documentation requested. If any part of the request is unclear, don’t hesitate to seek clarification before responding. 

2. Be thorough and accurate and provide detailed responses. Answer each question or concern comprehensively. Include relevant patient history, clinical findings, and rationale for your decisions. Use Evidence-based information and support your response with up-to-date clinical guidelines, peer-reviewed studies, and evidence-based practices. 

3. Maintain professionalism and stay objective. Avoid emotional language or a defensive tone. Focus on facts and clinical reasoning. 

4. Address all points and systematically respond. Where appropriate, explain why certain actions were taken, especially if they deviate from typical practices. If the peer review has identified areas for improvement, acknowledge these and indicate steps for remediation or learning. If the peer review suggests alternative approaches, discuss how these could be integrated or why your approach was suitable for the specific case. 

6. Adhere to any deadlines provided. If you need more time, request an extension with a clear explanation. 

7. Keep records. Maintain copies of the peer review letter, your response, and any supporting documentation. This is crucial for future reference or if the issue escalates.