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Quality Improvement Programs for Practice Groups

By Laura A. Petersen

Introduction

Quality improvement programs are designed to improve quality of patient care and reduce morbidity and mortality. While healthcare providers are familiar with the peer review process in a hospital, most do not contemplate using a quality improvement program in a practice group. However, having a quality improvement program for a practice group will improve quality care, improve patient satisfaction, reduce litigation risk, and save money. This article discusses (1) the Illinois Medical Studies Act, which serves as the foundation for maintaining quality improvement program confidentiality; (2) the basics of a quality improvement program in the practice group setting; and (3) the benefits of having such a quality improvement program.

Illinois Medical Studies Act

Two provisions of the Illinois Medical Studies Act are the most important in protecting quality improvement activities from disclosure in medical malpractice litigation. The first limits the information which can be admitted in evidence in a trial. The second provides that much of the quality improvement information can be protected from discovery before trial.

While the Act’s language is very broad, the courts have limited its protection. The statutory privilege is still absolute. So long as information falls within the purview of the Act, it is absolutely privileged and cannot be disclosed in a subsequent malpractice case. The privilege cannot be waived, even if the information is accidentally disclosed.

However, most of the Illinois Supreme Court cases have disallowed the privilege. The courts have ruled that information must be generated or used by a peer review committee after the committee has met to discuss it to trigger protection. The Medical Studies Act protects documents which arise from the workings of a peer review committee and which are an integral part of the peer review process. However, the Act does not protect information which results from the peer review process (i.e., ultimate determination). The courts have also denied the privilege when information is generated before the peer review process officially started. Under the case law, once the peer review process has been instituted, minutes of those meetings and discussions in those meetings will be protected. However, until the peer review process is officially started, information including conversations are not protected. Informal conversations and discussions will not be protected even if they are for quality improvement purposes. The most prudent course of action is not to have any discussion about a quality improvement matter until it is before an official peer review committee as part of a structured quality improvement program.

Practice Group Quality Improvement Program Issues

Our firm develops quality improvement programs for practice groups and advises practice group consultants on various aspects of the peer review process. A practice group must be closely involved in creating a peer review program because the group’s practitioners and administrators know which issues should be reviewed and what type of program will work best for the group. The quality improvement program will be driven not only by the nature of the group’s specialty, but also by the number of practitioners, the amount and type of procedures performed, type of care provided and the culture of the practice. It is essential to remember that a peer review program is designed to be prospective. It should prevent future errors and improve quality of care, thereby reducing morbidity and mortality. It is not designed to point fingers.

A quality improvement program will generally include certain key components set up through policies and procedures. For example, there would be an overall policy describing the program, including a mission statement, organizational structure, goals and objectives, quality improvement activities, criteria and standards to be used, and evaluation and monitoring of the program. There would also be policies specifically detailing the precise peer review process, the committee makeup, record audit process, meetings, and confidentiality issues. These policies serve as the roadmap to the program’s peer review process.

The group must also formally adopt the program. Once the committee is appointed, the committee members would work to develop policies and procedures with assistance of counsel which would then be approved by the board of directors. All of this should be reflected in corporate minutes to ensure there is appropriate documentation of a formal process. This is necessary should the validity of the quality improvement program be challenged in malpractice litigation.

Groups should also consider which individual will be responsible for coordinating the meetings, gathering charts for peer review, and serving as a contact person should a practitioner want an immediate review of a certain matter. The individual’s role is generally as an administrative nature, but that individual would serve on the peer review committee. In small groups, this can be one of the healthcare providers or the practice group administrator. In larger groups, a individual may be designated as the quality assurance director, quality improvement officer, medical care coordinator, etc., and have his or her job duties limited to quality improvement functions.

Counsel can assist with establishing the procedures, but it requires input from the group. Developing a quality improvement program takes some time, but it will run efficiently once a proper program is established.

Benefits of a Practice Group Quality Improvement Program

The ultimate benefit of a quality improvement program is improved patient care. By evaluating care, healthcare providers can evaluate systems and determine improvements to prevent negative outcomes in the future and further improve positive outcomes. This increases patient satisfaction and ultimately can increase patient-to-patient referrals based on the satisfaction and quality of care the group provides.

Another benefit of an established program is that it keeps these quality improvement activities protected under the Illinois Medical Studies Act. It is essential that these activities remain confidential. The quality improvement program is not a way to hide things from litigation. However, it is designed to prevent disclosure of information that is designed to truly improve patient care.

Finally, there is a direct economic benefit in having a quality improvement program. With less negative outcomes and higher patient satisfaction, practice groups save money. Not only can it reduce malpractice claims, thereby reducing malpractice premiums, it can have a direct impact on insurance rates. Some insurers offer discounts to practice groups that implement a peer review program. Even if an insurer is not willing to offer a discount, a practice group will save money over time by having the better outcomes and increased patient satisfaction.

Originally published in the Spring 2009 edition of Quinn Quarterly.