Peer
Review
Peer Review Assistance Workshops
The American Dental Association, Office of Quality Assessment
and Improvement, conducts up to 10 peer
review assistance workshops each year for state dental associations.
The purpose of the workshops
is to present the Association's recommendations
on the structure and conduct of peer review programs, and to
discuss peer review
issues of interest to the state association.
State dental associations may request a peer review assistance
workshop by contacting the
Office of Quality Assessment and Improvement.
The workshops are one day in length, usually from 9am to 2:30pm. The agenda consists of a power point and video presentations
by a member of the Council on Dental Benefit Programs and basic
training in mediation and peer review issues. Much time is allotted
for questions and discussion. The state association is encouraged
to include a presentation or report by its legal counsel and/or
its peer review chairperson on topics relevant to the state.
The American Dental Association provides the faculty free of charge
and pays for the faculty's transportation, lodging and meals
costs. The American Dental Association also provides peer review
manuals and other workshop materials. The state association hosting
the workshop is responsible for providing meeting space, announcements
or invitations to attendees, a VCR and monitor, and a screen
for projecting the power point presentation. The state association
may also opt to provide refreshments and lunch for attendees.
It is recommended that the number of attendees be at least 10.
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Peer Review Manual and Brochure
The American Dental Association’s manual, Peer Review in Focus, and its brochure, Dentistry’s Dispute Resolution Program: A Peer Review Process are now available for download. The manual and brochures are reviewed every year to update the information. 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 manual, Peer Review in Focus. The American Dental Association’s brochures, Dentistry’s Dispute Resolution Program: A Peer Review Process, is a summary of the purpose and process of the peer review program. It serves as a convenient overview that can be given to parties who are about to participate in peer review.
- Download Peer Review in Focus | PDF file/260k
- Download Dentistry’s Dispute Resolution Program: A Peer Review Process |
PDF file/39k
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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. A good
source of information on reporting and querying the NPDB can
be found at www.npdb-hipdb.com .
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 1-800-767-6732.
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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.
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How the Dental Peer Review Program Works and What you can Expect From it
This paper explains in detail how a dentists can navigate the peer review system and what can be expected from it.
- Download How the Dental Peer Review Program Works | PDF file/133k
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Contact Information
Office of Quality Assessment and Improvement
Telephone: 312-440-2772
E-mail: ellekd@ada.org
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