Peer review is used in many industry sectors to delineate the use of people who are peers within an industry or an organization who review and judge a persons performance, work product or other behavior. Peer review has been used for years as a part of academia to review professors qualifications and credentials. Peer reviews have also been used in other circles such as accounting and finance. But in the area of health care, peer reviews commonly refers to physicians who look at medical cases in order to make an objective third party decision.

Peer review is also a substitute for the phrase independent medical review, where physicians are looking at cases to provide claims decisions for health insurance payers, workers compensation insurance payers, disability insurance payers, etc. Peer review also defines the review of sentinel events in a hospital environment for quality management purposes, such as looking at bad outcomes and determining whether there was any misdiagnosis, mistreatment or any systemic problems involved which lead to that event.

Peer review, independent medical review, hospital peer review, medical peer review, all of those terms are really interchangeable today. Unfortunately in the healthcare environment everybody uses their own vocabulary to talk about the same thing. Today Peer Review at AllMed Healthcare Management is really a substitute for the words that we prefer to use, either independent medical review or hospital peer review. In either case, the core peer review function is to take physicians who are not a party to a particular treatment but who are board certified and in active practice in that same area of treatment, and have them examine certain cases in order to provide objective, unbiased determinations on what the root cause of the treatment waswhether or not there is medical necessity, if there was a sentinel event, what was the reason for it, etc.

I hope this clarifies the use of those different terms.