USA Today Debates Lack of MCO ‘Bad Doctor’ Reporting in Opposing Viewpoints Column

The new HHS Office of Inspector General report, which found that most MCOs rarely report incompetent doctors to the National Practioner Data Bank, "casts doubt on managed care's quality-improvement claims," an editorial in USA Today states. By law, hospitals, MCOs and medical boards must report malpractice judgments, sanctions and other findings of "ineptitude" to the database, but the OIG study found that 84% of MCOs reported nothing in the last 10 years. USA Today says that MCOs have not all "contract[ed] with stellar physicians" and must have some problems to report. The managed care industry "throws up a raft of excuses" about its failure to report bad doctors, the editorial maintains. MCOs say that they contract with so many doctors, making it "tough to detect bad" ones, the editorial says. In addition, some MCOs say that they were unaware that they were supposed to report directly to the databank and instead have been sending reports to state medical boards. But USA Today says that "an industry committed to quality would know how to file these reports," pointing out that the American Association of Health Plans "even publicized" the databank reporting guidelines. In the future, the editorial suggests that the government open the databank to patients whose reporting would counteract MCOs "that fail to post relevant information about doctors." But "[b]etter still would be for MCOs to make good on at least one of [their] promises. If the industry really cared about high-quality care, it would aggressively report on bad doctors without prodding," the editorial concludes (USA Today, 5/31).

Catch-22?
However, in an accompanying opinion piece, AAHP President Karen Ignagni says that health plans are "caught in a Catch-22" -- federal law requires health plans to report disciplinary action to states, but the databank guidebook also calls for "direct reporting to it." AAHP requested clarification on the reporting guidelines from the federal government, Ignagni says, pointing out that a "careful reading" of the HHS OIG report reveals that the plans "have been following what they understood to be the correct procedures." Ignagni adds that health plans support the databank's goal -- protecting patients from errors and other incidents at the hands of physicians. She maintains that the report "gives short shrift" to health plans' quality improvement efforts, pointing out that health plans contract with "carefully screened networks of physicians who meet high professional standards." The report fails to address the "culture of blame rampant in the health care system," Ignagni writes, calling for a "shift in the debate." She concludes, "Policy makers and the media need to prioritize the patient safety and quality of care challenges confronting health care. Let's stop affixing blame and fix the problems" (Ignagni, USA Today, 5/31).