Thought this was interesting and decided to post to our list.
later and hugs,
cindy
Medicare to Propose Lifting Ban on Disclosing Doctors' Mistakes
NEW YORK (Reuters Health) Jan 03 - Federal health officials are
contemplating whether to reverse a longstanding policy that prevents
Medicare beneficiaries from obtaining information about physicians who
may have made mistakes in caring for patients.
The policy switch under consideration would allow peer review
organizations (PROs), which contract with Medicare to ensure quality
care, to disclose the findings of investigations they conduct into
patient complaints, even if a physician objects. Currently, PROs may
release hospital-specific findings but are required to obtain a
physician's consent to disclose doctor-specific data.
In practice, the information that patients receive is limited because it
is difficult to reveal the results of a probe without disclosing the
physician-specific findings, an industry source told Reuters Health.
The Health Care Financing Administration (HCFA), which administers
Medicare, is trying to come to grips with the dilemma. HCFA is in "the
beginning stages" of crafting a proposed rule soliciting public comment
on allowing PROs to disclose information on the performance of doctors
and other healthcare practitioners, an agency staffer told Reuters
Health.
That proposal, which may be released later this year, would seek
feedback on what information should be revealed to patients and their
families in the "final disposition" of a complaint, he explained.
In the interim, HCFA intends to issue "clarifications" to its PRO
manual, Reuters Health has confirmed. In the next week or so, the agency
intends to reiterate its position that PROs may provide "appropriate
information" as long as they don't identify individual doctors or other
practitioners.
The clarification comes in response to a lawsuit filed against the US
Department of Health and Human Services and HCFA by the son of a
Medicare patient whose mother died 7 days after being admitted to
Memorial Hospital in Jacksonville, Florida.
Alan Levine wrote to Florida Medical Quality Assurance Inc., a Medicare
PRO, on February 1, 1999, requesting a review of the care his mother
received. In August, he got a letter from the PRO saying that it had
completed its review but that it could not inform him of the results
because his mother's attending physician, Dr. Richard Boehme, did not
consent to the disclosure.
Mr. Levin and Public Citizen, a co-plaintiff in the case, contend that
the government's instruction manual prohibiting PROs from disclosing the
results of a probe when a doctor doesn't consent violates a federal law
that entitles beneficiaries to have that information.
"I don't frankly see why they think they have a right to keep the
results of investigations secret," said Amanda Frost, a staff attorney
for Public Citizen Litigation Group, which filed the suit.
Debbie Carson, a spokeswoman for the Florida PRO, declined comment
because of the pending litigation.
HCFA concedes that the effort to clarify its instructions was sparked by
the lawsuit but maintains that a broader policy shift is still in the
conceptual stages.
Congress established PROs in 1983 primarily to ensure that Medicare was
paying for medically necessary care. Since then, PROs have evolved to
focus much more on quality improvement.
Exposing practitioners responsible for shoddy patient care raises new
and more complicated policy questions, sources suggest. Should the
federal government be involved, for example, in fact-finding missions
that provide fodder for malpractice suits? By identifying physicians by
name, would the PROs undermine their ability to get physicians to report
information used in reducing errors and improving patient care?
"A lot of this comes down to the question of what PROs should be," Dr.
John M. Eisenberg, director of the federal Agency for Healthcare
Research and Quality, told Reuters Health.
"PROs are a quality improvement arm of Medicare, which wants to be a
valued-based purchaser. It basically wants to buy the best care for its
beneficiaries," he explained.
In the US, licensing and accrediting functions are handled, by and
large, by state and private organizations, he added.
Dr. Eisenberg, a former chief of medicine at Georgetown University in
Washington, said that peer review would become a "thorny issue" for
PROs. Doctors and other healthcare professionals may be less willing to
critique each other if they thought that information would end up in a
court document, for instance.
A spokesman for the American Medical Association said that the
organization had no comment at this time.
In the view of patient advocates like Frost, the issue is more
clear-cut. "Part of being a Medicare provider is having the quality of
your services reviewed by the government," she said.