The Peer Review System and How It Works
The Fort Worth District Dental Society offers the Peer Review process as a service to the public and dentists of the greater Fort Worth district. Its purpose is to resolve disputes concerning the quality and/or appropriateness of dental treatment. In addition to patient initiated complaints, Peer Review handles utilization review resulting from differences of opinions between doctors and third party carriers.
A Peer Review Committee, composed of FWDDS member-dentist volunteers, evaluates all evidence that is available pertaining to each dispute and follows specific guidelines in order to make a fair and impartial decision. If any party involved in the process feels that a Committee's decision is incorrect due to additional information becoming available or information that is contrary to the outcome of the review, an appeal may be made to the TDA Council on Peer Review. An appeal must be mailed within thirty (30) days of the date the letter of resolution is sent. Any decision of the Council is final and binding.
All disputes which are evaluated within the Peer Review Process must follow these guidelines:
- The responsibility for conducting Peer Review will be that of the local dental society of which the dentist is a member.
- Both parties involved must sign an agreement form prior to the beginning of Peer Review. A dentist who is a member of the FWDDS is obligated to cooperate and participate in the Peer Review process.
- A record release form must be obtained from the patient in order for a Peer Review Committee to legally obtain a patient’s records.
- If a Peer Review case goes to a panel hearing, the patient will be examined by at least three dentists unless the patient has had the treatment redone prior to the hearing.
- Both parties will have the opportunity to speak to the panel at the time of the hearing.
- The Peer Review panel will consider all information available and render a decision by letter explaining their conclusions.
- Both parties will be informed of appeal criteria in the resolution letter.
Although the Peer Review process can satisfactorily resolve the majority of complaints received, there are limitations which may disqualify a complaint from being reviewed. The following are complaints that are not handled within the process:
- Cases which do not meet the "time" criteria: a complaint will not be reviewed if treatment was completed three (3) or more years prior to complaint, or more than one (1) year from the date the patient became aware of the problem.
- Cases in litigation: the Peer Review process is an alternative to civil litigation, therefore a complaint will not be reviewed if either party has initiated litigation before or during the Peer Review process.
- Cases petitioning for monetary awards: requests for reimbursement of lost time from work, pain and suffering, mileage, etc. will not be reviewed by the Peer Review process. The system is not a punitive system, but rather an evaluative one.
- Cases not related to treatment: attitude and communication problems of a dentist or dental staff will not be reviewed by the Peer Review Process. These complaints are outside the purview of Peer Review.
If you have questions about the Peer Review Process please contact either Cindy Farris at FWDDS ([email protected]) or Debbie Rogers at TDA ([email protected])