Managed care companies don't report bad doctors, federal study finds.

Managed care organizations (MCOs) rarely report medical malpractice claims and disciplinary actions against their physicians to the National Practitioner Data Bank, according to a recent federal report.

From September 1, 1990, to September 30, 1999, MCOs reported only 715 adverse actions, according to the study by the inspector general of the Department of Health and Human Services (HHS). Eighty-four percent of the organizations (1,176 out of 1,401) did not report any adverse actions during this period. With nearly 100 million people enrolled in these organizations and hundreds of thousands of physicians associated with them, these figures constitute "nonreporting," the study concluded.

"When this information isn't provided to the data bank, hospital administrators are making decisions lacking the information they need," said Gary Fox of Miami, immediate past chair of ATLA's Professional Negligence Section. "Hospitals can unwittingly [hire] people ... who have medical rap sheets a mile long in another jurisdiction. That's the big danger."

Congress created the National Practitioner Data Bank as part of the Health Care Quality Improvement Act of 1986, after reports that physicians who lost their licenses to practice in one state were continuing to practice in another. State medical boards, professional societies, and health care organizations must report adverse actions they take against a physician that affect the practitioner's clinical privileges for more than 30 days. Insurers must also report medical malpractice payments made on behalf of physicians.

MCOs' increased enrollment in the 1990s has made them a significant potential source of data on doctors who have been disciplined. These companies use the data bank in their own credentialing processes: MCOs now account for about half of all queries to the data bank, according to the report, but they provide little input.

One likely explanation for their low level of reporting, according to the study, is their limited clinical oversight of participating physicians. In interviews with researchers, managed care officials described their organizations "more as administrative entities than as integrated health care delivery systems." Physicians in focus groups concurred, characterizing an MCO as "nothing more than a `bill-paying organization.'" The report noted that an emphasis on costs leaves MCOs with little incentive to devote many resources to assessing and improving the quality of medical care their physicians provide.

MCOs also rely too heavily on hospitals, physician practice groups, and state licensing boards to monitor practitioners, the study found. Managed care officials insist that these groups are more directly involved in health care delivery and thus are better able to identify questionable performers. However, according to the report, there is an "ample basis for questioning how well [these monitors] protect patients from those few practitioners who can be dangerous."

In related news, the consumer group Public Citizen has found that federal drug officials do not report to the data bank doctors who give up their licenses to prescribe drugs. The group is calling on Attorney General John Ashcroft to require that the Drug Enforcement Agency report these physicians, who often surrender their licenses after facing drug charges. The group's research found at least 2,592 such physicians who were not reported.

Also, the federal government is planning to issue detailed ratings of the quality of care provided by nursing homes, Medicare health plans, dialysis centers, and eventually, hospitals and doctors. The Health Care Financing Administration will base the scores on a half-dozen criteria, ranging from medical credentials to staffing levels. The data will come from both government inspection reports and customer surveys.

The HHS report, Managed Care Organization Nonreporting to the National Practitioner Data Bank: A Signal for Broader Concern, is available at www.hhs. gov/oig/oei/reports/a521.pdf.