A new study suggesting that hospitals disciplined fewer physicians in recent years has the consumer advocacy backer of the studyPublic Citizenclaiming hospitals have dropped the ball.
Lack of discipline?
Report says hospitals fail to keep doctors in check
But an official for the American Hospital Association says the statistics in the report say little on their own, and may actually reflect improvement by hospitals reining in physicians who break the rules.
The study, produced by Public Citizens Health Research Group, states that the failure of hospitals to discipline and report doctors endangers patients. The study also reports that nearly half of all U.S. hospitals have failed to file a single report to the National Practitioner Data Bank, a federal database that collects information on incidents in which a doctors hospital-admitting privileges were revoked or restricted for more than 30 days because of issues of competency or conduct. Underreporting to the NPDB suggests that hospital peer review is not fulfilling the public trust, the report said.
Peer review is an incredibly important function when it works well, said Nancy Foster, vice president of policy at the AHA. She questioned whether the decline in reports filed was necessarily a negative trend. What I dont know is how many hospitals should have filed a reportPublic Citizen has reached a conclusion that too few have, she said. Foster said hospitals are learning to better identify potential competency or conduct problems and are beginning to intervene earlier before sanctions have to be issued.
While not commenting directly on the Public Citizen report or its recommendations, Foster suggested a different course for improving peer review and the National Practitioner Data Bank. If this tool is not being used in the way that it should be used, then the first thing that weve learned is that you go back to the end-userin this case, hospitalsand ask whats working right and whats not working right. And then ask what can we, meaning HRSA, do to make it better? Foster said, referring to HHS Health Resources and Services Administration.
While information on how many hospitals within a state have filed reports is publicly available, data from individual hospitals are not. At a news conference, Sidney Wolfe, the founder and director of the Health Research Group and acting president of Public Citizen, goaded the Obama administration into changing this policy. An administration that prides itself on transparency should lead the way, Wolfe said. Later, he added that something ought to be done in this transparency-oriented administration.
HHS declined to comment for this article.
The NPDB was launched in 1990 and, as of December 2007, only 11,221 incidents had been reportedwhich is one-eighth of what the government estimated would be collected when the database was created under the Health Care Quality Improvement Act of 1986, the report said. According to Public Citizen, 2,845 out of 5,823 U.S. hospitals, or 49%, have never submitted a privilege sanction report.
Although a 3.7% rise in the number of reports filed was seen in 2007 (551 compared with 532 in 2006), there has been a general downward trend since a record 830 reports were filed in 1991 and the recent high of 687 reports in 2002 (See chart).
Noting that it is literally inconceivable that so few disciplinary actions have occurred in U.S. hospitals in the 17 years covered by the study, Wolfe declared, They are obviously playing games.
In fact, the Public Citizen study cites a 1994 report that alleged hospitals had purposely imposed disciplinary periods shorter than 31 days in an effort to sidestep the reporting requirements. In a letter to HHS Secretary Kathleen Sebelius, Wolfe and the studys author, Alan Levine, of Public Citizen, linked this dangerously low number of hospital-based disciplinary reports to lax hospital peer review.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.