08/13/2019

Peer review can help dentists resolve treatment disputes


What can you do when you get that dreaded call from a patient who is unhappy with your treatment, is demanding a refund and clearly doesn’t want to come back to your office? You might consider peer review as an option. Peer review is one of your many benefits as a CDA member.

CDA members are typically unfamiliar with the peer review process unless they have gone through it themselves or have served on a local peer review committee. Even those who are aware of peer review might not know that the program was recently enhanced to include informal mediation.

The purpose of the peer review program is to resolve disputes between patients and dentists, focusing on disputes about the quality or appropriateness of dental treatment. However, peer review offers the flexibility of giving a goodwill refund to the patient or having the treatment reviewed by peers.

When a patient calls CDA to file a complaint about treatment provided by a member dentist, CDA staff first encourages the patient to contact the dentist to resolve any concerns. If the dispute persists, the patient may initiate a request for peer review. The program is provided at no cost to patients and CDA members.

Peer review cases begin with informal mediation. A CDA staff mediator speaks with the patient and dentist to help the parties explore whether an amicable resolution can be reached. Often, increased tension results in loss of communication between the patient and dentist, but a neutral third party can help separate the emotion from the situation.

In mediation, some dentists choose to offer a full or partial refund for treatment as a good-faith gesture to resolve the dispute swiftly. If a patient and dentist agree to a resolution, the patient signs a comprehensive release of all claims in exchange for any refund. Many patients and dentists find mediation to be a less stressful option and an opportunity to move quickly to resolution, though it may involve a willingness to compromise on both sides.

If a patient and dentist do not resolve the dispute through mediation, the case will proceed to evaluative peer review, where a peer review committee reviews the case. Committee members are dental society volunteers who are trained to conduct objective and confidential reviews. Records from the treating and any consulting dentists are collected and reviewed in detail. The committee examines and/or interviews the patient, and the dentist has an opportunity to meet with the committee separately. After careful deliberation by the committee, a decision letter is sent to the patient and dentist. Each party has the option to appeal the outcome.

If a peer review committee finds the treatment unacceptable or inappropriate, the dentist refunds for the treatment (or pays the cost to correct any damage). There are no additional monetary awards for pain and suffering or lost wages. Patients agree to abide by the decision when the case is initiated and must sign a release of all claims to accept any refund.

Cases must be initiated by the patient; however, dentists may initiate an evaluative review in certain instances to appeal an insurance carrier’s denial of benefits. Patients usually become aware of the peer review program by speaking with a consulting dentist, contacting the dental society or conducting a simple internet search, but member dentists can even refer their own patient to initiate a case if assistance is needed.

The peer review program was created by the CDA House of Delegates in 1976 and has evolved significantly to its current status, with over 400 volunteer committee members throughout the state who share their expertise. In 2018, 60 disputes were resolved through mediation and 63 cases were resolved in evaluative peer review. Historically, approximately half of the cases in evaluative review are found in the dentist’s favor and half are found in the patient’s favor. The program does not advocate for either party. The patient and dentist agree to any settlement in mediation, and evaluative peer review is evidence-based with the outcome determined by a committee’s review.

Having an unhappy patient who complains about treatment can be stressful. Peer review is an alternative to costly and time-consuming litigation, and case information is confidential. When the real and emotional costs of litigation are considered, the peer review program at CDA is a great member benefit.

By virtue of membership with CDA, member dentists agree to participate in the peer review program. The Peer Review Manual outlines time limitations and treatment criteria for accepting a case into the program. The Council on Peer Review provides informational courses at CDA’s continuing education convention, CDA Presents The Art and Science of Dentistry.

Learn more about peer review.



Related Items

Three new businesses — CommonBond, HR for Health and WEO Media — have been added to the lineup of CDA Endorsed Programs that have been thoroughly researched, vetted and approved by CDA. Endorsed Programs bring members the lowest prices on products and services that their practices need from vendors they can trust. Members can get more information about these and other Endorsed Programs at CDA Presents in Anaheim May 16-18.

Of the nearly 3,500 professional liability claims The Dentists Insurance Company addressed between 2012 and 2017, many could have been avoided or mitigated had the dentist been more cautious about choosing which patients to accept into care. “Being selective in the patients you see goes a long way in avoiding trouble down the road,” said Taiba Solaiman, senior TDIC Risk Management analyst.

The Dentists Insurance Company reports several calls to its Risk Management Advice Line from practice owners facing irate patients. Typically, these cases stem from patients who are upset over unplanned expenses, treatment plans they consider unnecessary, failure to achieve expected results from cosmetic procedures or a dentist’s refusal to practice outside the standard of care when a patient attempts to dictate treatment.

Topics
Top