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Report: Bad-Doctor Database Is Anemic

Insurance companies aren't reporting problems, government says

MONDAY, June 4, 2001 (HealthDayNews) -- A database designed to protect patients from bad doctors isn't doing its job, a federal agency declares in a new study.

Over a nine-year period, health insurance companies reported only 715 incidents of discipline, a number that is way too low to be accurate, says the Office of Inspector General, an investigative arm of the Department of Health and Human Services.

In addition, only 16 percent of the HMOs and Preferred Provider Organizations that are registered with the database ever reported taking action against a doctor.

The database part of the nation's doctor-surveillance system "isn't working as well as it could," says George Grob, a deputy inspector general who oversaw the study. "You may have some bad physicians who get lost in the crowd or get passed on. Their history of bad performance is never documented."

The federal government formed the National Practitioner Database in 1986 after Congress heard that doctors were losing licenses in one state and then starting practices in another.

The information in the database, which is not available to the public, includes reports of discipline actions and malpractice judgments against physicians and dentists.

Although insurance companies haven't been sending information to the database, they do use it to check on doctors, the report says. The companies sent 8 million queries to it at a cost of $4 each.

Insurance companies "are receiving information, but they're not contributing much," Grob says.

Who's at fault? The report makes a number of suggestions. For one, it says that HMOs don't make doctor competence a top priority. Also, the report says, the companies rely on other organizations -- hospitals and state license boards, for example -- to keep an eye on doctors.

But those organizations are themselves limited in their vigilance, the report says.

For their part, insurance companies say that they received vague instructions from the federal government about how to use the database.

One guidebook did tell companies to send information to the database, but insurance officials generally referred to other regulations instead, says Susan Pisano, spokeswoman for the American Association of Health Plans, which represents 1,000 insurance companies. As a result, companies often ignored the database and reported disciplinary actions to state medical boards.

"There is a need to clarify exactly what the plans need to do," Pisano says, adding that there is a divide in the health system over the issue of protecting patients versus protecting physicians.

Grob says the government will update its instructions to health plans. But he suspects that the problem goes deeper than that.

In some cases, managed-care plans may dismiss bad doctors without leaving a paper trail, he says. "Rather than having some sort of official finding, they're just letting their terms end," he says. "They're not really taking action."

Another problem may lie in hospitals that aren't willing to share information about bad doctors. "A lot of the hospitals are afraid of getting sued for sharing information like this," Grob says.

What To Do

You can read the Inspector General report, but you will need Adobe Acrobat Reader.

The Public Citizen organization's Web site has information about how to check out your doctor.

You might also want to read previous HealthDay articles on insurance companies.

SOURCES: Interviews with George Grob, deputy inspector general, Office of Inspector General, Washington, D.C.; Susan Pisano, spokeswoman, American Association of Health Plans, Washington, D.C.; Office of Inspector General report
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