Peer Review

The Profession’s Tool of Self-Regulation

About Peer Review

• Peer review is a process by which the dental profession reviews and resolves problems or misunderstandings regarding dental treatment. Peer review exists for the benefit of the patient, the dentist and third party financial intermediaries.

• Every dental society has established a system of peer review to resolve any disagreements about dental treatment that a patient and a dentist have not been able to resolve themselves.

About Peer Review (continued)

• A peer review committee consist of dentists, and sometimes lay individuals, who volunteer their time and expertise to consider questions about the appropriateness of care, quality of care, or the professional fees for care..

• A peer review committee will initially attempt to informally mediate a problem. If necessary, the committee may meet to discuss the case, examine clinical records, talk to the patient and the dentist and, if necessary, arrange for a clinical examination.

About Peer Review (continued)

• The dentist and patient are informed of the committee’s decision and recommendation for resolving the disagreement, subsequent to their deliberations.

• It is hoped the committee’s recommendation will result in a mutually agreeable solution.

• If it does not, there is provision for one level of appeal within peer review, after which the American judicial system is the next course of action for the aggrieved party.

The Review Process

• A written request for peer review (but not relief) is submitted to the local dental society or state dental association.

• The request should include all necessary and appropriate documentation that would help to clarify or support the circumstances.

• The request is reviewed for completeness by the association’s administrative staff and referred to the peer review committee.

The Review Process(continued)

• The chairperson of the peer review committee reviews the request and appoints one member of the committee to attempt to mediate the problem.

• The mediator contacts all parties and attempts to reconcile the differences and resolve the problem. A clinical examination is not conducted during the process of mediation.

The Review Process(continued)

• If the problem is successfully mediated, a written report is submitted to the committee chair and the case is closed.

• If mediation is not successful, and further action is necessary, the chair is advised accordingly.

• A subcommittee of at least three members is appointed to review the case.

The Review Process(continued)

• The committee conducts and concludes its review and all parties are notified in writing of its decision and recommendations.

• If any of the parties is not satisfied with the decision and can show just cause for an appeal, the case can be appealed to a peer review appellate body.

• The decision of the appellate body is final, within the context of peer review.

• All information regarding a particular case is kept strictly confidential.

Summary

• Peer review provides an impartial, easily accessible, and generally expedient means for resolving misunderstandings regarding dental treatment.

• Peer review is not a court of law. It is a voluntary process that relies on good faith between dentist and patient, and their mutual interest in good oral health.