Peer Review

Download Mediation Form (for patients)

It is not only essential that justice be done; it must be perceived to have been done. Acting justly, as well as demonstrating that one has done so, is something that every man of good intentions wishes to do.

Professional persons assume this obligation in a special way. The individual dentist is expected to be sensitive to the patient's needs and be willing to discuss thoroughly and openly any problems and/or misunderstandings that may arise. But when you consider that there are nearly 400 million patient/dentist encounters each year, that dental benefit plans and the dental health care delivery system has grown more complex, it is easy to understand how disagreements and misunderstandings occur. Consequently, a more formal method of response has been developed - PEER REVIEW.

Peer review is a confidential and a voluntary mechanism by which the dental profession demonstrates publicly the appropriateness of the treatment and the quality of the care it renders. It is an expert and credible mechanism for resolving disagreements. It is expert because men and women with appropriate credentials help conduct the hearing, review the evidence and make objective decisions based on their findings. It is credible because of this manual which clearly sets forth uniform policies and procedures to be used throughout the state. In addition, the mechanism allows each participant an equal opportunity to be fully heard; makes patients, dentists and third party payers aware of its existence, and provides for the utilization of lay representation on peer review committees.

The strength of the peer review mechanism is the ability to function effectively, fairly and expeditiously. It is a public demonstration that Ohio's dentists provide excellent care for their patients and that the dental profession has taken the initiative to correct problems that may arise. The goal is prompt, honest handling of disagreements by vigorous, fair review in a uniform and organized method that safeguards individual rights.

The Ohio Dental Association House of Delegates through its Council on Dental Care Programs and Dental Practice has established the peer review mechanism in Ohio. Its Statewide Subcouncil on Peer Review is responsible for monitoring the system and acts as the appellate mechanism. There are 25 local peer review committees, each consisting of a chairman and a full committee that may include laypersons.

Peer review committees are fact-finding bodies of dentists serving voluntarily. They review, mediate and arbitrate differences between patients and dentists, and dentists and third party payers. They are concerned with, but not limited to, the quality of care and/or appropriateness of dental treatment. They attempt to solve these problems, clarify areas of misunderstanding, educate the participants and establish or re-establish communication where they do not exist.