A new law signed by Massachusetts Governor William F. Weld in August will make public, for the first time, profiles of individual physicians that will include malpractice experience, disciplinary actions, and criminal convictions. The profiles also will include basic biographical information on physicians’ medical education and training, specialty, board certification, honors and awards, professional publications, hospital afffiliations, and health plan affiliations.
Consumer groups were quick to praise the innovative legislation and to express hopes that it would spur broader disclosure in other states.
"The real story behind the story is how the medical society, a state regulator, and consumer groups worked together to get helpful information out to people. It shows movement," said Sandy Fleming, executive director of the Massachusetts Board of Registration in Medicine, which is responsible for compiling and distributing physician profiles under the law (H5662).
At press time, physician profiles in Massachusetts were to become available through 800-number phone lines by Sept. 20. Until late in the legislative process, the profiles were slated to become available electronically on CD-ROMs at libraries throughout the state, and eventually on the Internet. However, the final law stalls electronic distribution until physician concerns about "the impact of publication of physician profiles by electronic media on the personal safety of physicians and their families" are addressed in a Board study due Jan. 1, 1997. Electronic distribution is not permitted prior to May 1, 1997, by which time the parties anticipate the safety concerns can be resolved.
Malpractice Data
One of the most controversial features of the legislation was how to include malpractice information in the profiles. "Physicians have had serious concerns that information about medical liability claims be accurate and fair," said Joseph M.
Heyman, MD, president of the Massachusetts Medical Society. "We’re pleased we could get safeguards addressing those issues."
One of the most controversial features of the legislation was how to include malpractice information.
According to Mr. Fleming, the profiles will not list specific judgments, payments, and pending actions against the physician. Instead, malpractice data on the physician will be put into the context of the malpractice experience of physicians in that specialty and in the state. The individual physician’s malpractice data will be based on paid claims only. Dollar amounts will not be disclosed, only the number of payments made. The profile details five fields:
• the total number of physicians in the specialty;
• the number and percent of physicians in that specialty with malpractice payments in the last ten years;
• the average number of payments for physicians in the specialty who have made payments in the last ten years;
• the number of payments for the individual physician; and
• whether the physician’s payments were average, above average, or below average relative to his specialty and all state physicians. Dollar amounts will not be disclosed.
Several disclaimers will preface the physician-specific malpractice data. For example, the profile explains that physicians treating high risk patients are more likely to have paid claims. "To make the best health care decisions, you should view this information in perspective," a draft profile reads.
"You could miss an important opportunity for high quality care by selecting a doctor based solely on malpractice history."
Consumer groups question how valuable this malpractice data will be. "I think the Board is taking a very narrow view on the malpractice items and financial settlements," said Deirdre Cummings, director of consumer affairs, Massachusetts Public Interest Research Group. "I think it fails to give consumers enough information to really understand what a malpractice settlement is all about."
Ms. Cummings also criticized the decision to exclude information on consumer complaints to the Board and on the outcome of those complaints. "Most consumers won’t realize you can still get those complaints, but you have to make two separate phone calls, and ask specifically for it."
Maryann Napoli, associate director of the Center for Medical Consumers, believes pending malpractice actions should be included, particularly since these actions often drag on for years. "We really need to know what kinds of malpractice actions have been filed against the doctor. There have been cases in New York where patients have been hurt. We want to know what it is, not just the averages."
Disciplinary Action Data
Final disciplinary actions, such as revocation or involuntary restrictions of privileges, taken by hospitals, the Board, or HMOs, after due process, as well as criminal convictions reported by the courts, also will be listed on the profiles. The profile states that criminal conviction data may not be complete because of incomplete reporting by the courts.
"I don’t think consumers will see very many," remarked Mr. Heyman, Medical Society president. "I think they’ll find that the vast majority of doctors in this state have outstanding records."
Yet to be resolved are specifics on remediation for physicians who are facing complaints and disciplinary action. Currently, physicians can voluntarily enroll in a remediation program if they have substance abuse problems, for example, as an alternative to disciplinary action in certain cases. The new law authorizes the Board to develop and implement a remediation program in cases of clinical competence.
"We’re getting bogged down with the Medical Society on this," noted Mr. Fleming. Recently, the Society charged that Board involvement could have a "chilling effect" on physician participation. "The Board needs to be involved," argued Mr. Fleming,"because people accuse medicine of hiding bad doctors. For all the best intentions, the Society is not a public watchdog." The Medical Society is developing its own pilot remediation program.
"I think, with the cooperation of the Governor and the Medical Society, we could establish a clinical competency evaluation center, for use not only by the Medical Board, but by HMOs, and other states," said Mr. Fleming. The Board is now staffing a new Quality of Care Unit to identify physicians appropriate for remediation, and not discipline.
As the first year of implementation begins, other states, medical societies, and consumer groups will be closely watching the Massachusetts physician profiling. Before releasing the profiles, the Board had the state’s 27,000+ physicians verify the information and add optional data.
"I think the real value will come when you can sit down at a terminal in your library and ask it to give you all the doctors in the Boston area, who are ob/gyns in HMO Blue," said Mr. Fleming, who is concerned that the three 800 lines will be swamped "I think the public will get a lot of busy signals. It’s not a state of the art way to find a doctor in 1996."
Contact the Massachusetts Medical Society at 617-893-4610; Mr. Fleming at 617-727-1788, ext. 321; Ms. Napoli at 212-674-7105; or Ms. Cummings at 617-292-4800.
This article was written for SHW by Laura Newman, a New York-based health-care writer.
Under new Massachusetts law, public will have access to profiles of state doctors
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