Hospitals, HMOs ‘Rarely’ Report ‘Incompetent’ Doctors as Required, HHS Report Says

Despite a federal law mandating that managed care organizations and hospitals report disciplinary actions against doctors for incompetence or misconduct, 84% of HMOs and 60% of hospitals did not report a single "adverse action" from 1990 to 1999, according to a new report from the HHS inspector general. The New York Times reports that HMOs reported 715 adverse actions in this 10-year period to the National Practioner Data Bank, created by Congress in 1986 "to protect patients against doctors who move from state to state without disclosing that they have been censured or disciplined in some way for providing poor care." A 1999 Institute of Medicine study found that medical errors are responsible for up to 98,000 deaths a year. According to the OIG report, HMOs have become "bill-paying organizations" that "often have little incentive to devote many resources to quality assessment and improvement." Carmella Bocchino, vice president of the American Association of Health Plans, said that many HMOs do not report errors because they are not aware that they were "required to tell the government when doctors were disciplined for incompetence or misconduct" (Pear, New York Times, 5/29). The report found this explanation "plausible" and called for an outreach program "to clear up any such misunderstandings" (Associated Press, 5/29).

Liability Fears
The fear of lawsuits is apparently driving the low level of reporting, the Times reports. Margaret O'Kane, president of the National Committee for Quality Assurance, said, "Health plans are very nervous about reporting to the databank because they are afraid of being sued by doctors." Managed care executives said that health plans sometimes negotiate "quiet deals" with incompetent doctors in which the doctors resign from the plan in exchange for not being reported to the database. Moreover, the report found that while HMOs "assume that hospitals and physician groups will evaluate the quality of care and report incompetent doctors," hospitals typically only do a cursory review. While doctors critique their colleagues in peer review sessions, both providers and insurers "are reluctant to share information about the performance of individual practioners" because of liability concerns, the report found. Sen. Ron Wyden (D-Ore.), author of the law creating the databank, said, "The inspector general's study sounds an alarm bell. The databank is only as good as the information that goes into it. Health plans ought to do more than just pay lip service to the goal of quality in health care" (New York Times, 5/29). To read the full report, click here. Note: You will need Adobe Acrobat Reader to view the report.