What is Peer Review?

Peer review is a mechanism for members of the Wisconsin Dental Association that provides an expert and credible system for resolving disagreements with patients, dentists and third-party payers. Peer Review is a process which identifies and analyzes relevant facts involved in disputes about professional dental services, quality of care and appropriateness of care that cannot be resolved in a less formal manner. Decisions and recommendations are reached in a fair and objective manner, based on the evidence provided. The overall purpose of Peer Review is to assure and improve dental health care in Wisconsin.

How does Peer Review work?

The WDA Peer Review process is entirely voluntary in nature. The purpose of Peer Review is to improve the quality of dental health care in Wisconsin. Eligible matters for review include those which appear to involve substantive issues of appropriateness of care and quality of treatment. If the complaint is determined to be eligible for Peer Review, it is then referred to the appropriate component dental society Peer Review Committee. The component Peer Review committee chairman will appoint an investigative designee to contact all parties involved to obtain information and, if possible, to reconcile differences. If the case is resolved by the investigative designee, a written report is submitted to the chairman who then forwards it to all persons involved and the WDA Executive Office. The case is then considered closed. 

If resolution of the matter is not reached during this investigative stage, the component Peer Review Committee chairman will send a letter to the dentist asking if he/she would prefer to have a Peer Review Committee meeting or hearing conducted. A committee meeting or hearing shall be conducted by a committee composed of at least three members. If the dentist chooses a Peer Review Committee meeting, each party is first interviewed by the committee separately and in person, in an effort to hear all sides of the situation.

If the dentist chooses a hearing, the dentist and his/her counsel (if the dentist chooses to have counsel participate at the hearing), shall be given the opportunity, both prior to and at the hearing, to submit documents, records and evidence; examine documents, records and evidence; present witnesses; establish pertinent facts and circumstances; question or refute testimony and evidence; and confront and cross-examine adverse witnesses (including the opposing party). The complainant and his/her counsel (if the complainant chooses to have counsel present), will also have the same rights as the dentist prior to and at the hearing. The hearing differs from a committee meeting in that counsel can also be present, documents and witnesses can be examined ad cross-examined (including the parties), and that the patient and dentist are in the same room at the same time. 

If it is necessary, an examination will be conducted to determine if the dental care the patient received was within acceptable standards, if the treatment was proper for the condition of the mouth, and if it was technically correct. 

Following the meeting or hearing, a report is compiled containing the specific complaint, the clinical findings, the conclusions reached by the committee, and the committee's recommendations. A copy of this report is sent to all parties involved. Each party is advised of the right to appeal the decision of the component dental society Peer Review Committee within 30 days. 

Additional information

For more information on Peer Review, please contact the Wisconsin Dental Association at 414-276-4520, 800-364-7646 or info@wda.org.