 As you will read about in a later section, significant efforts were taken in 2023 to review, organize, and standardize all review workflows, peer reviewer worksheets, final reports, and conflict of interest forms to reduce duplication and complexity.
This was done in preparation to transition from home-grown spreadsheets and databases to a technology partner, Salesforce. Salesforce allows for a more contemporary approach, supports the desire for growth, and lets us have dedicated and state-of-the-art client and peer reviewer portals.  When I joined CIMRO in late 2018, I was not entirely sure what to expect. I had been involved in plenty of peer review through my various hospital committees and leadership positions, so peer review I knew well. But the insurance review portion would be new to me. I love case reviews, but don’t we all? Don’t we all love to chat with our colleagues and doctor friends about interesting cases we’ve seen, hard cases we solved, and those cases that absolutely astound us? Don’t we love to ask the question, “So what would you do if…?”
 It isn’t downhill snow skiing, martial arts, or SCUBA diving, but Dr. Brad Weir is still excited about joining CIMRO as its new chief medical officer.
In addition to those adrenaline-fueled hobbies – a goal is to climb Pike’s Peak – Weir’s medical background is in emergency medicine and EMS. In addition to work as an ED physician at Carle Foundation Hospital in Urbana, IL, he serves as its EMS medical director and associate quality officer. He also is an EM educator with the University of Illinois/Carle Illinois College of Medicine, and associate clinical professor at the college of medicine.  In addition to a new chief medical officer, CIMRO has named a new associate chief medical officer, Dr. Mary Belford.
She follows Dr. Ronald Johnson in that position. See below for responses to questions recently presented to both Dr. Johnson and Dr. Belford.  This notice serves as a reminder that the Certification and Acceptance statements you previously signed remain in full force and effect. You have agreed to abide by the letter and spirit of CIMRO’s Confidentiality Policy, Conflict of Interest Policy, and Code of Business Conduct.
You also acknowledged your understanding and agreement that any failure to fully comply with the letter and spirit of the Code, including any related confidentiality and/or conflict of interest activities and their reporting requirements, will be grounds for immediate termination of employment, subcontract, other contractual relationship or removal from the Board of Directors, as the case may be.  A frequent question related to liability protection arises in conjunction with peer review activities. The Health Care Quality Improvement Act of 1986 (HCQIA) provides good-faith immunity from state and federal liability for people participating in the peer review process.
CIMRO's contracts with our clients specifically address the fact that our peer review decisions are considered part of internal quality improvement processes, which further affirms the protections afforded under HCQIA.  We are in a new era! CIMRO will be transitioning our peer reviewer platform from email and ShareFile to Salesforce. Salesforce will provide our Peer Reviewers with a more streamlined review process.
Once you have accepted a review from CIMRO and we have received all the needed information from the client, you will be assigned the review within the Peer Reviewer Portal. Once logged in, the portal will contain everything needed to complete your review: The patient records, the client’s questions, areas to write your case summary, answers to each question, and, if applicable, list references utilized.  Watch Your Language!
Likely every reviewer has at least once been presented with a case and related questions that seem so straightforward that there isn’t much to say. A hospital may want an explanation for a bad outcome after a routine procedure. There may not be an obvious answer. A physician can do everything correctly, but something still goes wrong. In such cases, it may be tempting to answer the question, “What caused this outcome?” with "pure, dumb, bad luck".  Number of Medical Records received: 1,578
Independent Peer Review reports completed: 590 External Review reports completed: 94
 CIMRO added two review staff members in 2023: Brandi Woodward, MSN, RN as review coordinator, and Amy Jo Adams as credentialing and review project specialist. Brandi is brand new to CIMRO, while Amy Jo is making a return to the team.
Brandi joins the other review nurses in supplying clients with the information and education they need to ensure providers are giving – and patients are getting – the best care possible. She interacts with clients and reviewers all along the journey from assignment of cases to delivering the final product. |
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