Launching Peer Review: Information and tools for physicians

December 15, 2017

Hello Members:

Peer review resources are ready for your use

As part of our drive for physician stewardship, the Representative Forum has supported development of a peer review mechanism. This was negotiated as part of the 2016 Amending Agreement.

The AMA has established an internal Peer Review Committee (PRC) to lead this work. The RF has directed that the committee’s work should be:

• Physician-led
• Non-punitive
• Focused on education

Accordingly, the PRC will use anonymized Alberta Health data to focus on billing issues, not on individual physicians. The mandate is to encourage appropriate billing through education, or through changes to the Schedule of Medical Benefits (SOMB) system or the AH claims systems where necessary. The PRC goal is that savings associated with peer review should be accomplished through education, and not through audits.

Providing input and locating resources

The PRC has been working hard over the last year and is now ready to release their summary document – AMA Peer Review 101. This document describes the processes the new committee will follow.

Ongoing educational work will happen in a few different ways.

• A new Billing Matters newsletter
• Direct consultations with sections
• Updates to the AMA Fee Navigator^®

To provide input or ask questions:

• AMA members and sections can submit anonymous suggestions through a new web portal.
  • Please note that this is a place to identify billing issues and educational activities. Comments should be limited to billing issues and not identifying specific individuals.
  • It requires an AMA log in, but physicians have the option to make their suggestions anonymous.
• Contact the PRC through email at peer.review@albertadoctors.org

What about the other parties?

Because it will be necessary to liaise with AH and Alberta Health Services regarding peer review, we are in discussions to set up a separate joint committee so that:

• Education efforts can be coordinated
• Physicians are not audited while PRC is clarifying billing practices
• SOMB and billing system changes can occur as needed
• Billing profiles can be distributed to physicians
• Feedback can be given on audit processes and decisions.

We are pleased to move forward with this important AMA leadership and stewardship initiative. As always I appreciate your feedback.

It would be especially helpful if, when you comment, you tell me a little about yourself, where you are from, what your specialty is and what setting you work in. You can give feedback in three different ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org
• By commenting publicly below 
• Share your perspectives with colleagues in our new Discussion Board for members only (member log in required).

At your service,

Neil D.J. Cooper, MD, FRCPC, Dip. Sport Med.
President