Peer Review

I have always wanted to be the best at what I was doing, if it interested me. Otherwise I did not care about it. This could help explain why I got Top Honors for 7th grade Algebra while getting an F in 7th grade English (life may have been better if other way around, my spelling has not improved).

When I started at Blue Cross in 1977 my goal was to be the best auditor there. I vowed that when I knew more than the approximately 120 people in the department and had learned all I could from them I would consider another job. By the early 1980s that goal was accomplished but other reasons kept me at Blue Cross until January 1989.

At Blue Cross we had periodic meetings of the senior auditors and supervisors to discuss Medicare audit issues in our auditing of Hospital Medicare cost reports. At one of the meetings I suggested that we conduct internal peer reviews. All audits were reviewed by supervisors who varied in their approach and findings but that was not my issue. I was advocating that senior auditors could learn from each other and we would all improve by peer reviews. If Walt’s audit was reviewed by Mitch, it would help one or both of them. Likewise, if my audit was reviewed by Stan and I reviewed Mitch’s, etc. The other senior auditors “shouted” me down in horror at the idea.

In the early 1990s the National Association of Home Care (NAHC) had an advisory committee, mostly of consultants, that reviewed issues for discussion and research. This committee would eventually become the core of the Home Care & Hospice Financial Managers Association (HHFMA). I am proud to have been a member of both the committee and HHFMA since 1994. At a meeting of the committee, about 1995, I suggested, unsuccessfully, to the members that we consider doing peer reviews. Cost reports prepared by me could be reviewed by Jim, and so forth as similar to my proposal at Blue Cross. The problem here, of course, is that the consultants are all from different firms and no one wanted to have their work looked at by competitors. My effort to improve the body and standard of work did get me on the NAHC subcommittee to create a certification for home care financial people. The effort collapsed by 1998 due to the industry’s problems with the major and disastrous Medicare reimbursement change called the Interim Payment System (IPS).

Today neither peer review nor a certification program for home health care financial people is on the horizon. Times change and perhaps neither is needed today and certainly other issues are more pressing for the home health care community.

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