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A national report found hospitals don’t do enough to discipline problem doctors and said many exploit loopholes to avoid reporting physicians to a national database.
A federal law requires hospitals to report physicians to the National Practitioner Data Bank who have had their admitting privileges revoked or restricted for more than 30 days.
But the report released Wednesday found nearly half of all hospitals in the country – and 48 percent or 72 hospitals in Indiana – hadn’t reported a single doctor to the data bank since it opened in September 1990. Data for the report by consumer-advocacy organization Public Citizen were collected through December 2007.
Locally, some hospitals said they had reported doctors to the database while others hadn’t. Doctors and hospital officials say doing so equates to a black mark that can profoundly affect a physician’s career.
Given that, officials acknowledge some reluctance to take that step but say peer review and other methods are used to keep doctors in line. Hospital officials said they follow the law in reporting doctors.
Public Citizen’s report said hospitals’ failure to adequately discipline doctors or report disciplinary action to the database is a problem. The report says the failure robs state medical boards of crucial information for regulatory oversight and potentially puts patients in harm’s way.
The organization urged changes, including penalties for hospitals that don’t meet legal reporting requirements.
Underreporting to the database has been widely documented, but the magnitude captured by Public Citizen’s report is “just shocking,” said Dr. Aaron Carroll, director of the Center for Health Policy and Professionalism Research, an Indiana University think tank in Indianapolis. He wasn’t affiliated with the study.
Although the law requires such reporting, Carroll said, it is essentially a voluntary act because it’s not regulated.
Hospitals have many incentives not to report problem doctors, Carroll and others said. Reporting might make the hospitals look bad, particularly if those doctors remain on staff. Also, other doctors who see that a hospital has reported several physicians might be less likely to seek privileges. And there’s economic incentive to hang on to physicians, especially surgeons who perform lucrative procedures, according to anecdotal accounts.
Parkview Hospital – which shares a license with Parkview North – has reported to the database, but not all hospitals in Parkview Health system have, spokesman John Perlich said. He didn’t provide specifics, but a health system official said the overall number is low.
Citing confidentiality, none of the hospital officials interviewed gave specifics on disciplinary actions. Hospitals and medical associations can access the databank, but identities of reported doctors aren’t available to the public.
Betty Brown, chief quality officer for Parkview Health, said the system tries to prevent problems before reaching the point where a doctor must be reported.
When hiring doctors, Parkview Health looks at a mountain of information, such as previous performance ratings and reviews from fellow professionals, she said. When records show a physician has taken a break from practicing, the health system seeks reasons.
Lutheran Hospital’s chief quality officer, Mary Ellen Brill, said physicians must go through a “rigorous process” to get and keep privileges at the hospital. Brill said the hospital has reported physicians to the database, though she didn’t have a number.
At least three of eight hospitals in Lutheran Health Network have reported doctors. Spokesman Geoff Thomas declined to identify which others had reported and said there were limits to getting a precise count. In addition, The Orthopaedic Hospital of Lutheran Health became a licensed hospital in June 2008, after the survey period for the report ended. Dupont Hospital opened in April 2001, more than 10 years after the databank opened.
Officials with the Fort Wayne VA Medical Center and DeKalb Memorial Hospital in Auburn also said they have reported physicians to the database.
