The drive to publicize more physician data is gaining steam. This month, a sweeping New York state law requiring public access to a broad range of provider information takes effect, and the Federation of State Medical Boards is poised to open to consumers its databank of state disciplinary actions.
These, and concurrent events, are chapters in an ongoing saga. It remains unclear how the tale will end.
Consumers are petitioning Congress to make public the National Practitioner Data Bank, despite fresh doubt about the database's credibility cast by a General Accounting Office report released in November. Many in healthcare contend states are doing a sufficient job of physician profiling, increasingly making data that is understandable to consumers available via Web sites and toll-free numbers.
Meanwhile, the Dallas-based Federation of State Medical Boards is set to open its Federation Physician Data Center, a 40-year-old database of 115,000 state board disciplinary actions involving 35,000 doctors nationwide. Historically, this databank has been open only to those in the healthcare community, including employers evaluating potential hires.
Such professionals obtain better information from the federation and insurance companies than from the NPDB, says Warren McPherson, M.D., a Murfreesboro, Tenn., neurosurgeon and board chair of the Rockville, Md.-based Physician Insurers Association of America. "The public is best served by the states."
But Robert Milligan, an attorney and director of Gallagher & Kennedy's healthcare practice in Phoenix, isn't convinced the avenue by which the public gleans information about providers matters.
"Nationally, there's a definite trend toward disclosure of everything," Milligan says. "What I tell my clients is, 'so what?' Ultimately, if you're a good doctor, a global move toward information will help you."
For those who see the trend in a less favorable light, one hot-button issue is the push to open the NPDB, a clearinghouse created in 1986 to alert credentialing agencies to inept doctors setting up shop in a new state. The congressionally mandated GAO report asserts the databank is riddled with inaccurate, duplicative and incomplete data.
Neil Sampson, deputy associate administrator of the Bureau of Health Professions division of the Health Resources and Services Administration, says the databank is "fairly accurate" and that the GAO's report primarily underscored problems already acknowledged by HRSA, which oversees the databank.
Sampson says HRSA faces a hurdle in overcoming the underreporting GAO cited because it lacks the legal muscle to force private entities to disclose information. "We don't have authority there. That's one of the reasons we haven't forced it."
The national databank is nevertheless valuable to professionals seeking top-notch practitioners, Sampson says. "Our concern is the way it's structured right now, it may not be that useful to individuals. Most of the actions in the databank happen to be malpractice payments."
And that's another sticking point: Should malpractice records, which are less commonly available in state databanks and absent from the federation's, be provided to consumers who may lack the ability to analyze that information?
No, says Bruce Wilson, director of government relations for PIAA.
Malpractice risk varies as a function of specialty, geography and even a physician's personality, Wilson says. Insurance companies are financially motivated to settle rather than litigate, and innocent doctors often choose settlement over protracted and stressful litigation that might result in a judgment exceeding policy limits.
New York City-based Art Levin, director of the state's Center for Medical Consumers and a stong advocate of the recent legislative reform there, objects to such reasoning. "'The public's too dumb' is always a defense of censorship."
Levin says many providers mistakenly believe that unscrupulous attorneys file unmerited malpractice lawsuits willy-nilly, but statistics say otherwise.
"There's a lot of evidence that this 'out of control' problem ain't so out of control. I'm not going to say our tort system is the best thing since sliced bread (but) lawyers who take frivolous cases are not going to eat very much."
Ninety percent of New York's state-licensed provider profiles published as a result of the new law will not contain any malpractice data because only those with three or more settlements in the past ten years will be listed, says Levin.
A Web site disclaimer discouraging overemphasis of legal history is under construction, and profiles that include malpractice records will compare apples to apples. "We're not comparing family practitioners to neurosurgeons."
Wilson says many states rightly disseminate only disciplinary and state licensure actions, which are more reflective of physician competence than malpractice history.
But states have not decided on the matter. Medical boards, legislatures and medical societies struggle to balance public demand for information and providers' right to protection from imperfect or misleading records that unduly malign.
Massachusetts led the pack in 1996 when it pioneered a physician profiling program, says Stephanie Norris, policy associate with the Health Policy Tracking Service of the National Conference of State Legislatures in Washington. Other states have since joined the bandwagon to varying degrees.
While Virginia, Tennessee and Florida passed legislation in 2000 modifying existing provider profile laws, New York netted the biggest legislative gain, says Norris. "New York didn't have anything on the books prior to the 2000 session."
New York's law establishes a patient safety center within the state health department and makes available via the Internet and a toll-free number a spate of healthcare information: hospital report cards; health plan data; and physician profiles detailing education, criminal convictions, disciplinary actions, privileging affiliations and suspensions, malpractice history, contracted health plans, publications, partners and more.
It also requires health department reports on patient privacy, physician credentialing and nonphysician provider data.
Levin says he believes New York got it right. "I think our healthcare system should be transparent, and I think people should have access to all the information that's legally available--in one convenient place."
The vast provisions of New York's legislation blazed a trail, says Norris, who has been contacted by other states seeking to enact similarly extensive statutes in 2001.
Patricia Donnelly, one of three women fueling the New York law, lost her 4-year-old grandson during minor surgery in 1997.
While most physicians are "wonderful," Donnelly says, healthcare consumers need protection from incompetent providers and deserve unfettered access to data about doctors, hospitals and health plans on which to base informed decisions.
She is among those calling for federal legislation opening the NPDB. "We have a right to it," Donnelly says. "We have more information on mechanics and contractors than we do on the people to whom we entrust our lives. It's not right."
The AMA is in favor of consumer access to disciplinary and licensure actions, and supports states disseminating that data, but opposes publicizing the "flawed" NPDB, says Thomas Reardon, M.D., the immediate past president. Eighty percent of the national database relates to malpractice, and statistically only one in five such lawsuits involve actual negligence, says Reardon. "It's not the type of information patients can use to make good decisions."
Reservations about unveiling the NPDB have been compounded by the GAO's findings.
Leslie Aronovitz, healthcare program administration and integrity director of the GAO in Chicago, spent nine months evaluating the contents of the NPDB before releasing the report.
"We were very interested in looking at the reliability of the databank because there have been some concerns on the Hill and in the physician community," says Aronovitz. "We found some problems that clearly surprised us. We think the Health Resources Services Administration needs to do more to assure the accuracy of the information in the databank."
The GAO did not weigh in on the issue of opening the databank, Aronovitz says. "That's for Congress to debate."
Attorney Milligan says the "fix" is not shielding the faulty database from public view but repairing its defects.
"You can either try to stop the wave or go with the wave, but the trend toward more information will not be stopped by objecting the data may not be right."