Paralyzed by partisan politics, Congress this year failed to act on two significant pieces of legislation affecting organized medicine--a federal antitrust exemption for competing doctors and increased public access to physicians' disciplinary records.
With the departure of the measures' key sponsors, it's unlikely Congress will move quickly on either initiative when the 107th Congress convenes in January.
Rep. Tom Bliley Jr. (R-Va.), House Commerce Committee chairman, championed the effort to open the National Practitioner Data Bank to the public, but he will soon retire from Congress, throwing the initiative into limbo.
Meanwhile, Rep. Tom Campbell (R-Calif.), who led the fight for physician antitrust exemptions, lost his bid to unseat incumbent Sen. Dianne Feinstein (D-Calif.). Without his guidance and political gamesmanship, the controversial antitrust measure could face tough hurdles.
"I just don't see a lot of prospects for it," said Jim Edwards, a spokesman for the Healthcare Leadership Council, a nonpartisan trade association that opposed the antitrust exemption, along with groups representing consumers, employers, health insurers, hospitals and nurses. "I would say the chances are moderate to slim (the exemption will even be considered)."
Last summer the House overwhelmingly approved Campbell's proposal to allow competing physicians to skirt antitrust constraints to bargain collectively.
But the measure, strongly supported by the American Medical Association, was doomed when Campbell couldn't find a Senate sponsor willing to butt heads with Republican Majority Leader Trent Lott (R-Miss.), said to be a determined foe of the AMA.
Donald Palmisano, M.D., a New Orleans surgeon and a member of the AMA's board of trustees, said he is confident that new sponsors will successfully carry the legislation through Congress next year.
"Our commitment has not diminished one bit," said Palmisano, who testified at congressional hearings on the legislation. "When the next president is installed, this will get passed."
Though Palmisano wouldn't hint at the identity of potential sponsors, the most likely candidate in the House might be Rep. John Conyers (D-Mich.), the Commerce Committee's ranking Democratic member and one of many co-sponsors of Campbell's bill last year.
Bliley had a greater struggle finding support for his proposal to open the National Practitioner Data Bank to public viewing on the Internet. Unlike Campbell, whose bill passed the House easily, Bliley couldn't rally enough support to win even a single vote for the legislation in his own 43-member Commerce Committee.
The decade-old databank tracks malpractice judgments and certain disciplinary actions against doctors and other healthcare professionals. Hospitals, HMOs, professional societies and state medical boards query the databank when credentialing physicians so they can be aware of any action taken against a physician in another state. Consumer groups have tried, but failed, to win access to the information.
Only six members of the House--three Republicans, three Democrats--joined him as co-sponsors of the doomed legislation, opposed by the American Hospital Association as well as the AMA.
Pete Sheffield, a Commerce Committee spokesman, said Bliley is not conceding defeat and might try to call a vote on the measure during the current lame-duck session of Congress, which is scheduled to resume Dec. 5 and could continue well into the Christmas season.
"Why was it stalled?" he asked. "You can point to one group--that's the American Medical Association."
The AMA said it believes public access to the database might provide incomplete or confusing information, perhaps causing some consumers to make the wrong choice about doctors. AMA officials said states--not the federal government--should have the responsibility to provide accurate public information about physicians. Almost 75% of the physician information in the databank involves malpractice payments, which do not necessarily correlate with findings of negligent care, the AMA said.
In fact, said Richard Corlin, M.D., president-elect of the AMA, only "23% of malpractice payments relate to negligence."
"We need to address this issue in a rational and appropriate manner," Corlin said. "Which is to say that the states have the data, the states are the ones who do the research. We need to coordinate it and make the appropriate information public through the states."
Asked whether he expects the legislation to resurface next year, Corlin said, "I'd be very surprised if it did."
Sidney Wolfe, M.D., director of Public Citizen's health research group, which closely monitors disciplinary actions against doctors, said he plans to lobby hard next year for a bill similar to Bliley's.
His public-interest group publishes an annual list of "Questionable Doctors"--the most recent of which listed 20,125 physicians.