Peer Review Resources

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Peer Review Webinars

Peer Review 101: A Review of the Fundamentals, Structure & Best Practices

This webinar covers peer review as an alternate dispute resolution mechanism and an important member benefit. The webinar is useful for staff from state dental association and peer-review committee members.

The Mediators Dilemma: Case Studies in Peer Review

Peer Review is an important member benefit providing an alternative dispute resolution mechanism. This webinar recaps the ADA’s guidelines for peer-review while analyzing case studies allowing participants to learn how challenging cases were mediated. This Webinar aims to help the participant develop an understanding about the clinician’s role in peer review complaints and better ways to mitigate risk for disputes in dental practices.

Presenter Information

Dr. Henrik Hansen is a past member of the ADA Council on Dental Benefits Programs, and Quality Assurance and Improvement subcommittee chair (dealing with peer review). He is past chair of the CDA Council on Peer Review and a past CDA trustee. Other previous CDA service includes as chair of the Screening Committee and as a member of the Judicial Council, Leadership Development Committee, and Periodic Boundary Review Task Force. Currently, Dr. Hansen is a Deputy Regent, International College of Dentists and member, Northern California Board of the American College of Dentists. He is also past president and editor of the Napa-Solano Dental Society.

Dr. Stephen Simpson is a Board-certified orthodontist with over 30 years of experience as a clinician, educator and leader in organized dentistry. He is a former president of the Ohio Dental Association and the Ohio Association of Orthodontics, and past chairman of the Ohio section of the American College of Dentists. He received the Distinguished Dentist award by the Ohio Dental Association in 2015.

Peer Review Manual and Brochure

The American Dental Association Peer Review Manual, flyer, brochure and mediation checklist are now available for download. The manual and brochures are reviewed every year to provide the most up to date information available. Constituent and component dental societies may use or adapt portions of the manual or the entire manual. The American Dental Association supports the profession's peer review programs, by providing recommendations on how the peer review programs should be organized and conducted, and the considerations that are inherent in the evolution of peer review policy. Those recommendations are presented in the American Dental Association's Peer Review Manual. The American Dental Association's brochures serve as a convenient overview that can be given to parties who are about to participate in peer review. The mediation checklist will give an overview of the process one would follow.

Peer Review Actions and the National Practitioners Data Bank

The National Practitioner Data Bank (NPDB) was established in 1986 under the Health Care Quality and Improvement Act of 1986. The NPDB is an information clearinghouse that collects information related to the professional competence and conduct of physicians, dentists and, in some cases, other health care professionals; the information is released upon request to eligible entities.

Depending on the facts and circumstances of a case, a fee refund resulting from peer review could be a medical malpractice payment, reportable to the NPDB by the dental society or the dentist, whoever makes the payment.

A "medical malpractice payment," as interpreted by the U.S. Department of Health and Human Services (HHS) is: (1) any payment of money; (2) by an entity; (3) for or for the benefit of a health care practitioner; (4) resulting from a written claim or demand for payment; and (5) based on the provision of, or failure to provide, services. Each of these elements must be present in order for a reporting obligation to exist. You can view a good source of information on reporting and querying at the NPDB Website.

Access to the NPDB is limited. For example, patients, at this time, may not query the data bank. Attorneys may query the NPDB only if they represent a plaintiff in a malpractice action against a hospital and an issue is whether the hospital queried the data bank, as it is required to do by law, before granting staff privileges to a specific practitioner. The practitioner must also be a defendant in the case. A dentist may query the data bank about him or herself, but not about others. For information on how to query the data bank, call 800.767.6732.

Peer Review Programs

State dental associations conduct peer review programs to settle disputes between patients and dentists or third-party payers and dentists. Disputes that may be addressed through peer review involve appropriateness of care, quality of care or whether a fee in question is the dentist's usual fee for a procedure, based on the difficulty or complexity of the dental procedure.

The procedure for initiating peer review is to contact the component (local) dental society and request peer review. The component society conducts the peer review and coveys its decision to the dentist and other party involved in the peer review. Under some circumstances, decisions of the peer review committee at the component level can be appealed to the state dental association by either the dentist or the other involved party.

How the Dental Peer Review Program Works (and what you can expect from it)

This paper explains in detail how a dentist can navigate the peer review system and what can be expected from it.