Peer Recommendations

Question 1

The Joint Commission
Peer Recommendations

Answer 1

The medical staff must use peer recommendations in its consideration of recommendations for appointment and initial granting of privileges and in consideration of termination from the medical staff or revision/revocation of clinical privileges.
Peer recommendation includes written information regarding the physician’s or other licensed practitioner’s current
- medical/clinical knowledge
- technical and clinical skills
- clinical judgement
- interpersonal skills
- communications skills
- professionalism
Note: Peer recommendation may be in the form or written documentation reflecting informed opinions on each applicant’s scope and level of performance, or a written peer evaluation of physician - or other licensed practitioner - specific data collected from various sources for the purpose of validating competence
Peer recommendations are obtained from a practitioner in the same professional discipline as the applicant with personal knowledge of the applicant
The following are appropriate sources for peer recommendations:
- an organization performance improvement committee, the majority of whose members are the applicant’s peers
- reference letter/s, written documentation, or documented phone conversation/s about the applicant from a peer (practitioner in the same professional discipline as the applicant) who has personal knowledge of the applicant
- a department or major clinical services chairperson who is a peer
- The MEC
When renewing privileges, if there are insufficient practitioner specific data available, the medical staff uses and evaluates peer recommendations

Question 2

NCQA Health Plan
Peer Recommendation

Answer 2

There is no specific requirement for peer recommendations. The organization must designate a Credentialing Committee that uses a peer-review process to make recommendations regarding credentialing decisions. The intent of this standard is that the organization obtains meaningful advice and expertise from participating practitioners in making credentialing decisions.

Question 3

ACHC
Peer Recommendations

Answer 3

For initial appointment, recommendations/references must be obtained from at least one, but preferably three peers with the same professional credential as the applicant that includes a statement regarding the physician’s physical and mental health in relation to privileges requested.

For initial applicants, references should be obtained from the Residency Program Chair or a Department Chair.
If there is not one peer with the same professional credential available, then a practitioner in the same practitioner in the same practice area who can speak to the applicant/re-applicant’s professional competence and ethical standards can provider the reference.
For physicians seeking reapplication, individual letters of recommendation are not required. For reapplicants, routine review functions; such as clinical peer review, medical records review, credentials function, and Medical Executive Committee is sufficient.
Clinical competence review must be a component of recredentialing.

Question 4

DNV NIAHO for Hospitals
Peer Recommendations

Answer 4

MS SR4(c) and MS 8 SR1(b)
Bylaws describe the qualifications to be met by a candidate in order for the medical staff to recommend that the governing body appoint the candidate. Those qualifications shall include two peer recommendations on initial appointment

Question 5

URAC Health Plan
Peer Recommendation

Answer 5

There is not specific requirement for peer recommendations other than that a peer group makes the final credentialing determination.

Question 6

AAAHC for Ambulatory Health Care
Peer Recommendation

Answer 6

Peer references are required for initial appointment.
At reappointment, peer references and/or peer review activities and results are incorporated into the decision-making process.

Question 7

Medicare Hospital COPS and Interp Guidelines
Peer Recommendation

Answer 7

Not specifically addressed