A report by consumer watchdog Public Citizen claims that nearly half of all hospitals have not submitted a single physician's name to the National Practitioner Data Bank, which provides reviews of healthcare practitioners' professional credentials.
The National Practitioner Data Bank was established by the Health Care Quality Improvement Act of 1986 as a searchable resource for hospitals and other medical entities to check practitioners' backgrounds. The legislation included a requirement that hospitals report to the NPDB whenever they revoke or restrict a physician's hospital privileges for more than 30 days for problems involving medical competency or conduct.
When the database was created more than 17 years ago, federal officials estimated that hospitals would report approximately 5,000 cases a year. Since 1990, Public Citizen said, the database has averaged 650 reports a year.
Public Citizen's analysis of the NPDB Public Use File found that almost 1,000 physicians who had at least two adverse clinical privilege reports to the NPDB did not have any subsequent licensure board disciplinary action. One physician had nine adverse clinical privilege reports but no licensure board actions.
"It is impossible to justify the fact that thousands of hospitals, which collectively have granted admitting privileges to hundreds of thousands of doctors, have not reported a single discipline case in 17 years," said Sidney Wolfe, Public Citizen's acting president and director of its health research group. "Our report shows there is an urgent need for the Obama administration to step in and hold hospital administrators accountable as well as ensure that hospital medical staffs hold their own physicians accountable for patient safety."
Public Citizen's report points to two factors that could be contributing to the lack of hospital reports. The first is lax peer review or a culture among doctors of not wanting to "snitch" on their colleagues. A July 2008 study for the California state legislature found problems in hospital peer review that resulted in "physicians continuing to provide substandard care (at times for years) impacting the protection of the public."
The second factor is reporting loopholes in which doctors who have been disciplined undergo actions that are arranged to evade the reporting requirements. A 1994 study of 144 rural hospitals by HRSA found that 20 percent of hospitals reported an increase in certain activities, such as imposing disciplinary actions less than 31 days (below the reporting threshold).
"Hospital peer review has been called one of the pillars of quality assurance in the U.S. healthcare system," said Al Levine, the Public Citizen researcher who compiled the report. "Based on all the data and reports we analyzed, it appears to be a questionably effective form of self-regulation that needs more accountability and better oversight. We hope our report is the tipping point for action by Congress and the Department of Health and Human Services."
Public Citizen wrote a letter to HHS Secretary Kathleen Sebelius on May 27 asking her to address many of the Inspector General's recommendations that have been made in the past but were never implemented, including:
- having the HRSA and Centers for Medicare and Medicaid Services work together to achieve a regulatory change so that hospitals' reporting responsibilities under the Health Care Quality Improvement Act are added as a requirement as one of the Medicare conditions of participation; and
- having HRSA seek passage of legislation that would establish a civil money penalty for each instance of a hospital's failure to report.
