Physician Peer Review

Injured workers frequently end up taking too many medications or the wrong kinds of medications for their conditions. Inappropriate pharmacy regimens pose health risks, such as drug interactions and dependency on or addiction to opioids and other drug classes. Plus, future pharmacy costs over a lifetime can be extraordinarily high — hundreds of thousands of dollars — presenting a significant barrier to settlement.

Tower MSA Partners is the only MSP compliance company that imbeds prescription drug triggers and physician peer review workflow into its settlement/MSA technology. When triggers are identified, we arrange to have a physician analyze the prescription drug regimen, compare it against state specific, evidence-based guidelines, and propose changes to the treating physician. There are three phases to our comprehensive Physician Peer Reviews.

  • Physician peer reviewer (always a practicing physician) conducts in-depth analysis of medication regimen, comparing it to evidence-based medical and pharmaceutical guidelines
  • Physician peer reviewer contacts the treating physician and discusses the drug regimen and current guidelines and asks the treating physician to change the pharmacy treatment
  • Tower secures the treating physician’s agreement to change pharmacy treatment — in writing — and conveys this to our client

Working with national networks of practicing physician peer reviewers, we handle all the details for you — from intake through providing the revised pharmacy treatment plan. A detailed peer review report explains exactly how the medications affect the patient’s health and your claims costs and shows the savings the new pharmacy program will achieve.

Of all our programs, Physician Peer Review and its companion service, Pharmaceutical Clinical Oversight, make the greatest impact on claims savings. We have seen initial settlement proposals drop from nearly $1 million to $200,000 on a single claim, from $200,000 to $20,000 on another, and from $350,000 to $78,000 on still another. Reducing the amount and type of inappropriate medications protects patient safety and greatly reduces the costs of settling claims.

To improve claim and settlement outcomes, the identification of pharmacy issues and pharmaceutical intervention should be an integrated into your MSP compliance program. Find out how Physician Peer Review can optimize your claims. Call 888.331.4941, email info@towermsa.com, or refer a claim.