April 18, 2014
In an increasingly litigious society, Peer Review may be one of the best member benefits that you don't know about. It can save you the headache of having to engage an attorney to defend yourself against patient claims that may or may not be valid, take years to resolve, and could easily spiral into tens of thousands of dollars in attorney fees and lost revenue, according to Dr. Kal Kass, Peer Review Chair for Seattle-King County Dental Society. “Nearly all dentists have had a patient dispute a fee or service unless they haven't been practicing long,” says Klass, “And for non-members, engaging an attorney will quickly cost more than your WSDA yearly dues.” Member dentists aren’t always aware of the process, according to Jennifer Freimund, Executive Director for the Seattle-King County Dental Society, who says, “I always take a moment to explain what would have happened if they were not a member, to further solidify how valuable belonging to the Society and the Association can be. They’re grateful about the process — being on the receiving end of a complaint can be very humbling — and they’re most interested in resolving the conflict in a way that is beneficial to all parties. Peer review creates an environment for just that.”
Peer Review starts with a phone call to your component society from a patient or another dentist. The person handling the call evaluates the complaint to see if it’s appropriate to move forward in the process. They will tell the caller what the peer review options are – what the program can and cannot do, and allow callers to choose whether or not to proceed. According to Dr. Rod Wentworth, past president of the WSDA, “The reality is most cases don’t go beyond intake — the vast majority of people who call in just want an opportunity to be heard and choose not to continue with a claim. The peer review process isn’t punitive – complainants aren’t going to get a trip to Hawaii out of it, and in our litigious society, the resolutions offered by peer review may not be satisfactory to someone thinking they’re going to reap a cash windfall. Just as importantly, the dentists involved in the dispute won’t be subject to censure. The process will determine whether the procedure was done appropriately, and whether or not the quality of care was adequate. If the dispute is resolved in favor of the patient, they can get a refund or have the procedure redone by the same dentist.”
If the complainant decides to move forward, a mediator is assigned to the case. The mediator contacts both parties and attempts to find a mutually acceptable solution. If they can’t, then both parties have the option to have a formal review with a peer review panel comprised of dentists. In order for the case to proceed, both parties have to agree to binding arbitration, and there is typically a clinical exam to review the case. Each party is allowed to present their case separately to the panel, which then makes a decision on the case. The benefit to the patient is that they don’t have to engage an attorney – actually neither party is allowed to — and patients have access to a process where their concerns are reviewed by a panel of the dentists’ peers. Every effort is made to ensure that the panels are comprised of dentists who don’t work with, or know well, the dentist involved in the case, and panel participants take their work very seriously.
Not every case is eligible for peer review, notes Freimund, “If someone complains about a community health, DSHS, or corporate practice issue, they’re not handled by our peer review process because they have their own. Complaints against non-members are immediately sent to DQAC.” And, notes Wendy Johnson, Executive Director for the Spokane District Dental Society, “We ascertain if the caller has already sought legal advice. If so, we don’t get involved at all. Ethically, our members have a responsibility to the patient, but there can be nuances to patient care that aren’t always black and white. We’d prefer that our members call the other dentist first to discuss the case, but that can be a very tough call, especially if the case involves a junior dentist critical of a procedure performed by a senior dentist. Sometimes, peer review is the only way to proceed, but in a perfect world dentists would talk with each other first.”
According to Cheryl Jenkins, Executive Director for the Pierce County Dental Society, “Peer Review is a really valuable resource for both the dentists and the patients. Most often what happens is that we call the dentist involved, describe the complaint, explain the peer review process, but nine times out of ten the front office has been running interference for the dentist, who is either unaware of the complaint or unaware of the severity of the problem. Most of the time the dentist wants to call the patient to resolve the issue. The best part is that the process is completely free for all parties. If it goes to panel review, the patient and the dentist both have to agree to binding arbitration, so no further legal action can be taken. Many members are completely unaware of that – they think they could go through the whole process and still be sued by the patient. While it is true that a patient could go through the mediation process and then refuse to go to panel, opting instead to take the issue to DQAC, most do not.”
Within the staffed component societies, peer review requests are handled at the local level. Peer review requests for unstaffed component societies are received at the state level and referred to the local component's committee. For additional information, contact Mike Walsh at firstname.lastname@example.org, or at 800-448-3368.