Credentialing and Peer Review

Davis Wright Tremaine provides credentialing and peer review advice, in not only the hospital medical staff context, but also with respect to health plans and physician organizations. Hospital medical staff credentialing and peer review activities have evolved from collegial, quality assurance activities to high stakes disputes that are frequently resolved through litigation. Hospitals (or members of the medical staff) may find that the initiation of a negative action against a particular provider can result in antitrust or other litigation while, on the other hand, failure to take appropriate action in such cases can result in a negligence lawsuit.

The firm's attorneys regularly advise clients regarding the preparation of hospital medical staff bylaws, the consideration of issues relating to allied health professionals and their membership on the medical staff (defining both the requirements imposed as preconditions to medical staff membership and the scope of privileges), procedures for emergency suspensions, and other disciplinary matters.

New forms of organization have emerged as part of the ongoing reorganization of the health system, including various forms of physician organizations, managed care organizations and payers. All of these organizations must credential their participating providers in order to enhance quality of care, avoid malpractice liability and implement risk-management initiatives. Moreover, certain regulatory schemes and accreditation bodies now mandate implementation of credentialing and peer review regimes.

Davis Wright Tremaine's credentialing and peer review practice has become national in scope. The issues addressed include deselection from physician networks, credentialing and peer review plans for independent practice associations and physician-hospital organizations, compliance with payer accreditation by the National Committee for Quality Assurance, and medical group accreditation by the Medical Quality Commission, an affiliate of the Unified Medical Group Association.

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