The New York State Society of Anesthesiologists is developing a model peer review program to fulfill state requirements for relicensure of physicians. It will involve centralized reporting of clinical quality assurance data about all anesthesiologists in the state.

In May 1986, Governor Mario Cuomo of New York State publicly announced his intention to require that physicians have their credentials periodically recertified in order to have their medical licenses renewed. This pronouncement was made approximately one year after Governor Cuomo signed a comprehensive medical malpractice reform bill designed to monitor and improve the quality of medical care provided to the citizens of New York State.(1,2,3)

Governor Cuomo requested that the Department of Health and the State Education Department appoint a committee to prepare recommendations for physician recredentialing. The report of that committee, the New York State Advisory Committee on Physician Recredentialing, was published in January 1988. It proposed that physician recredentialing be related to registration of medical licenses and that these processes take place every nine years. The Committee proposed that physicians who take care of patients in a hospital setting should have three options available for recredentialing: (1) specialty board certification or recertification; (2) cognitive and problem-solving examinations; and (3) peer review according to a specified protocol.(1,2,3)

The Committee stated in its 1988 report that the recredentialing process should not be punitive but should be directed toward education and remediation. Physicians judged to be practicing below given standards would be granted time-limited licenses to allow for remediation. If reassessment showed that deficiencies were not corrected within a reasonable length of time, the physician’s license to practice medicine might be suspended until the deficiencies were corrected.(1,2,3)

In 1989 the Committee on Quality Assurance and Peer Review of the New York State Society of Anesthesiologists (NYSSA) began developing a model program of quality assurance and peer review to meet New York State’s requirements for the recredentialing and relicensing of anesthesiologists. After the full committee met twice with NYSSA leadership to establish broad principles on which to base the model program, a subcommittee of NYSSA members began working out the details. Subcommittee members are Ronald A. Gabel, M.D. (Chair), Jared C. Barlow, M.D., John A. Gatell, M.D., Ingrid Hollinger, M.D., Marilyn A. Resurreccion, M.D., Albert J. Saubermann, M.D., Charles J. Vacanti, M.D., Mark D. Weibman, M.D., and Gerald L. Wolf, M.D.

To date (August 1992), the subcommittee has met for eight day-long sessions, six of them with Alfred Gellhorn, M.D., Director of Medical Affairs of the New York State Health Department and co-chair of the New York State Advisory Committee on Physician recredentialing. Through this process, NYSSA has developed a Model Program of Quality Assurance/Peer Review for Recredentialing/ Relicensure. This Model Program, which was approved by the NYSSA House of Delegates on December 8, 1991, is expected to meet the requirements of New York State for recredentialing and relicensing anesthesiologists according to a peer review process endorsed in the 1988 report of the New York State Advisory Committee on Physician Recredentialing. However, the Model Program is not yet fully developed, and the NYSSA Committee on Quality Assurance and Peer Review will continue working to complete and refine it. When approving the Model Program of Quality Assurance/Peer Review, the NYSSA House of Delegates specified that the Model Program was .accepted for implementation when all physicians are required to be recertified and relicensed by New York State, provided NYSSA plays a direct and active role in the implementation and administration of the Program.’

The overall philosophy on which the NYSSA Model Program is based is similar to that underlying the quality assurance program developed by Terry Vitez, M.D. (4) Physicians are human, and humans sometimes commit errors. (‘To err is human.”) A major goal of the NYSSA Model Program is to identify patterns of human error where they exist, enabling anesthesiologists to obtain remedial education or training when necessary. It is intended that this, in turn, will improve the quality of anesthesiology care provided to the citizens of New York State. The NYSSA Model Program is founded on the principle that the only appropriate method for identifying patterns of human error in anesthesiology practice is through peer review, a compassionate yet objective and rigorous assessment of performance by fellow anesthesiologists.

The NYSSA Model Program is essentially a standardized method of peer review. It includes procedures for case finding and for evaluating both process and outcome. The general approach taken is similar to that used in the quality assurance program developed by Dr. Vitez and endorsed by the American Society of Anesthesiologists (ASA) in 1989.(4) Additionally, the NYSSA Model Program requires anesthesiologists practicing in New York State to adhere to a rigorous set of clinical standards. Some of these standards are currently compulsory (New York State Health Code 405.135; others until now have been voluntary (three sets of clinical standards of the American Society of Anesthesiologists (6,7,8).

The NYSSA Model Program is not meant to replace existing programs of quality assurance and peer review. Rather, it has been designed specifically to meet the requirements of New York State for recredentialing and relicensing anesthesiologists. Many departments of anesthesiology have well established quality assurance programs that may be more complete and more effective in assuring high quality anesthesia care than the NYSSA Model Program. NYSSA not only supports and endorses these efforts to maintain high standards of self-assessment, but takes the position that individual quality assurance programs should exceed the requirements of the NYSSA Model Program. This program has been developed because NYSSA recognizes that the State needs to adopt a standardized approach to peer review in order to recredential and relicense anesthesiologists.

The NYSSA Model Program has been standardized to permit development of a statewide anesthesiology clinical profile containing information on the performance of all anesthesiologists practicing in the State. The aggregate profile will include information on both process and outcome, as well as on compliance with standards. This statewide profile will be used as a standard for evaluating the performance profiles of individual anesthesiologists. Conventional statistical methods will be used to compare the clinical profiles of individual anesthesiologists with the statewide profile. This mechanism will be used for identification of outliers who may need remedial education or training (depending on their performance profiles) before being recredentialed in anesthesiology or relicensed to practice medicine in New York State.

It is not clear when the need will arise to apply the NYSSA Model Program to the recredentialing of anesthesiologists in New York State. This depends on the details of legislation implementing the recommendation of the Advisory Committee on Physician Recredentialing. A tort reform bill is currently before the New York State Legislature to provide financial compensation for impaired newborns as a substitute for parents’ seeking damages for alleged malpractice. Tied to this bill is a requirement for obstetricians, pediatricians, and anesthesiologists to become recredentialed. The bill does not specify how this would be carried out if the legislation, as currently written, becomes law.

Most of the above article was extracted, with permission of the publisher, Little, Brown and Company, from: Gabel RA: Quality Assurance/Peer Review for Recredentialing/ Relicensure in New York State. International Anesthesiology Clinics 1992; 30:93-101.

Dr. Gabel, Professor of Anesthesiology at the University of Rochester, is Chairman of the Committee on Quality Assurance and Peer Review of the New York State Society of Anesthesiologists.

References

1 Gellhorn A, Cherkasky M. Report of the New York State Advisory Committee on physician recredentialing. Phase one: general principles, proposed process, recommendations. Albany, NY: Department of Health, State of New York, January 1988

2. Gellhorn A, Cherkasky M. Periodic physician recredendaling proposed in New York State. N Y State j Med. 1989;89:209-213

3. Gellhorn A. Periodic physician recredentialing. JAMA 1991;265:752-755

4. Vitez T: Judging clinical competence. Park Ridge, IL: American Society of Anesthesiologists, 1989

5. New York State Health Code. Part 405.13.1989

6. Standards for basic intra-operative monitoring. Directory of members. Park Ridge, IL: American Society of Anesthesiologists, 1991:67M71

7. Basic standards for pre-anesthesia care. Directory of members. Park Ridge, IL: American Society of Anesthesiologists, 1991:648

8. Standards for post-anesthesia care. Directory of members. Park Ridge, IL: American Society of Anesthesiologists, 1991:672-673