Dentists helping dentists
April 18, 2016
Navigating the peer review process over a dispute with a patient can be scary for dentists.
The fear is warranted because there’s a lot at stake: the dentist’s reputation, money and the possibility of a lawsuit. But for most dentists who participate in a peer review case, their state dental society is able to resolve it before it escalates.
“The ultimate goal is to try to keep complaints from going to the state regulatory board or the legal system,” said Chris Wilson, professional review assistant and practice management specialist for the Michigan Dental Association. “We’re also here for the public. We make sure the public is treated fairly in that if peer review deems the dental treatment to be unacceptable, we obtain a refund of their paid fees in order for them to seek retreatment.”
The Michigan Dental Association is one of three state dental societies — along with the Texas and Oregon dental associations — granted Peer Review Recognized status from the American Dental Association. This status is awarded to states that volunteer to participate and demonstrate that they meet certain requirements in documentation and conduct of their peer review program.
“The ADA’s Peer Recognition Program is the newest endeavor from the Association to provide an easy framework to review state dental societies’ peer review program structure and performance to ensure that best practices are incorporated into the administration of the programs,” said Dr. Ron Riggins, chair of the ADA Council on Dental Benefit Programs, which oversees the ADA’s peer review program. “Sharing and incorporating best practices will help us ensure that we have a strong dispute/resolution mechanism for the profession we serve.”
In Michigan, 98 percent of the complaints are filed by patients, and the state dental society generally will only take a case if the dentist is a member. Once a case is opened, MDA staff members request the patient’s records from the dental office, any subsequent treating doctors and the insurance company, said Ginger Fernandez, manager of professional review and practice management specialist for MDA.
They then send the complaint and the records to that dentist’s local dental society, which has member dentists review the case. When treatment is rendered by a specialist, the complaints are sent to the Michigan Dental Association’s specialty peer review committees. Some cases have to do with dental treatment, others involve ethical issues like advertising or professional demeanor, which are sent to the ethics committee, Ms. Fernandez said.
Dr. Michael Gonzalez, chair of the Council on Peer Review for the Texas Dental Association, said his state’s peer review process relies upon the individual committee member’s sense of fairness, objectivity, sound judgment and clinical skills. Cases are ultimately sent to the dentist’s component society’s peer review committee, which are comprised of licensed dentists, primarily general practitioners, who are elected by the general membership of that society.
“It also requires a commitment from the dental society for efficiency, expediency and responsiveness. Peer review provides a tangible opportunity for the dental profession to demonstrate its overriding concern for providing quality dental care to the patient,” Dr. Gonzalez said. “Peer review can achieve many positive outcomes, not the least of which is its potential to inspire improvements in dental practice management.
In Oregon, the state dental association won’t accept cases related to billing issues, which are sent back to the dentist for he or she to handle, said Lori Lambright, peer review director for the Oregon Dental Association. In Oregon, the anti-trust laws prohibit the Oregon Dental Association and its components from intervening in the determination of fees charged by dentists, Ms. Lambright said. Fees are a contractual matter between the dentist, patient and third-party payer, she said.
Once a patient files a complaint, the peer review director talks to the patient to determine if there is a communication issue that can’t be resolved before the peer review process begins, Ms. Lambright said. If the case needs to proceed, the Oregon Dental Association forwards the case documents to the dentist who chairs the state peer review council to determine whether it’s an appropriate case to pursue. From there, the case is sent to the chair of the dentist’s component society peer review committee, who selects a mediator.
“The mediator then takes over and talks to the dentist and the patient to see if they can come to a resolution that’s fair and equitable to both parties,” Ms. Lambright said. “In most cases, the mediator is successful.”
In 2015, the Oregon Dental Association took 107 phone calls with complaints. Twenty-four of those moved into official peer review cases and only one of those went to a hearing.
“This is a member benefit,” said Conor McNulty, executive director of the Oregon Dental Association. “It’s an alternative to other various forms of litigation that don’t help the doctor/patient relationship.”
The Oregon Dental Association took a cue from the ADA and updated its peer review manual based on examples in Peer Review in Focus, which includes the Association’s recommendations for how peer review programs should be organized and focused.
“We revamped our program based on the ADA’s examples for best practices,” Mr. McNulty said. “Peer Review in Focus is a great way to help calibrate and standardize peer review programs across the country.”
To access the ADA’s resources on peer review, click here