Medical peer review is the process by which a professional review body considers whether a practitioner’s clinical privileges or membership in a professional society will be adversely affected by a physician’s competence or professional conduct. The foremost objective of the medical peer review process is the promotion of the highest quality of medical care as well as patient safety. From American Medical Association, http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/medical-peer-review.page.
Because the healthcare entity is ultimately responsible for the quality of healthcare provided at its facilities, and can be directly liable to patients if it allows unqualified or incompetent physicians to practice in its facilities, it is important that the healthcare entity continually monitor practices of medical staff members and take appropriate actions to protect patients from substandard care. Adversely affected physicians often bring suits alleging: (i) antitrust claims, (ii) breach of contract claims, (iii) discrimination claims, (iv) defamation claims, and (v) other claims under various tort and contract theories. However, [the Health Care Quality Improvement Act] HCQIA provides a limited shield against such potential liability if the requirements of HCQIA are met. HCQIA was designed to encourage good faith peer review activities to improve the quality of healthcare and protect patients.
To be entitled to HCQIA protection, the four standards set forth in Section 11112(a) of HCQIA must be satisfied. Specifically, the professional review action must be taken: