Understanding Professional Review Activity [Health Care] and Its Legal Implications

Definition & Meaning

Professional review activity in health care refers to a process conducted by health care organizations to assess and manage the clinical privileges or membership of physicians. This includes:

  • Evaluating whether a physician should be granted clinical privileges or membership.
  • Investigating the scope or conditions under which a physician holds privileges or membership.
  • Determining if there should be any changes or modifications to a physician's privileges or membership.

Table of content

Real-world examples

Here are a couple of examples of abatement:

Example 1: A hospital conducts a professional review activity to determine if a newly hired surgeon meets the qualifications for surgical privileges. The review includes assessing their training, experience, and past performance.

Example 2: A medical board investigates a physician after receiving complaints about their practice. The review activity involves examining patient records and interviewing staff to determine if the physician should retain their privileges. (hypothetical example)

State-by-state differences

Examples of state differences (not exhaustive):

State Key Differences
California Requires specific documentation and peer review processes for all professional review activities.
Texas Has strict timelines for conducting reviews and notifying physicians of decisions.

This is not a complete list. State laws vary, and users should consult local rules for specific guidance.

Comparison with related terms

Term Definition Differences
Credentialing The process of verifying a physician's qualifications. Focuses on initial qualifications rather than ongoing performance.
Peer Review A review of a physician's performance by their colleagues. Specifically involves colleagues, while professional review can include broader evaluations.

What to do if this term applies to you

If you are a physician facing a professional review activity, it is important to:

  • Understand the process and criteria being used for the review.
  • Gather documentation of your qualifications and performance.
  • Consider seeking legal advice if you have concerns about the review process.

Users can explore US Legal Forms for templates that can help in preparing for or responding to professional review activities.

Quick facts

  • Typical Fees: Varies by organization.
  • Jurisdiction: Health care entities and state regulations.
  • Possible Outcomes: Approval, modification, or denial of privileges.

Key takeaways

Frequently asked questions

The purpose is to evaluate and ensure that physicians are qualified to provide safe and effective care.