Department of Health and Human Servces

OFFICE OF

INSPECTOR GENERA

PERFORMANCE INDICATORS, ANNUAL

REPORTS, AND STATE MEDICAL

DISCIPLINE: A STATE-BY-STATE

REVIEW

VIC. 
Richard P. Kusserow 
INSPECTOR GENERA 
"0 
ola  OEI-Ol-8-O563  EXECUTIVE  SUMMAR 
PUROSE 
In this study, we seek to contribute to the development and use of performance 
indicators for State medical boards. 
BACKGROUN 
How many complaints has a State board received? How many investigations has it 
intiated? How long has it taken to complete an investigation? How many 
disciplinar actions per licensee has it taken? How many nondiscipliary educational 
actions has it taen? In this report, we pose these and 
15 other basic questions 
about the performance of State medical boards, and then identif the extent to which 
they are answered in the annual report of these boards. We focus on questions 
concerng medica discipline, the sphere in which most of our prior work has been 
conducted. Questions concerng medical licensure are also of importance and 
warrant simar attention. 
FIINGS 
is  an  is 
Thir-thee Sta meal board  an  oth  biel report 
report 
quns 
anser to th  aner 
th report provi few  20  Tho  none of 
oth  an 
qutins at al 
 Th  rarel offer tren data  tyal prvi pa-yea data
th resnd to onl a few of the qutins. 
li 
conc 
report are mo  to antsear q 1uns4  . th nuer of complain 
srThe  cueied  an diciliry actins  reprt provi
In regard to  dipli 
complain  29 
th pa  prr  wel for  actins 
data for nuer year and  12  for  years as 
th CO"esndg 
are 30 and 
ti 
palacrk o fs intfgor.m tin concerg th proesg  un rev
Th  for cases 
For th three quns posed on th matt onl thee report
provi an informtin at all 
CONCLUDING OBSERVATIONS

major val of peormnce inators is th opport th can provi to make 
cTh ompaatie asests and to raise quns on how peorme can be improved 
We sugges th State lelatues mand thth th  baoan e sblih a ser of 
peonn  provi  reprt  th en 
inatrs and  data on  in  Toward 
Astir;
th Natna Conferene of State Lelatues, th Natina Goverrs 
Fedn 
Coun of Sta Goerts, th  Medal Boards an th Uni 
of State 
Puli Hea Sere 
Setxatge e  id  can pla valble supporte role as agen for
of  and informtin.  ........................................................................... . 
. . . . . . . . . . . ..  '..  ..  ..  ..  ..  ..  ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ... .  . ..  . .. .  . .. .  . .. .  . ...    ...   ..  ...  . 
. . . . ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  . ..  ..  . . . . . .. 
TABLE OF CONTENTS 
EX 
SUMY . 
INODUCfON . 
STATE MEICAL BOARS 
.A.A RER'f 
........................................ 3 
DEfCfON OF AIGED VIOlATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 5 
REVIW OF AIGED VIOlATIONS 
.. 14 
RELUTON OF CAS:E 
CONCLUDING OBSERVATIONS . . . . . . . . . . . . 
APPENIX A 
Endnotes 
APPENIX B

The Twenty Questions  .. B-1  INTRODUCTION

Performance indicators, expressed in terms of percentages and ratios, can be valuable 
mechanisms for assessing results and pinpointing accountabilty. In themselves they 
But they can serve as useful 
do not provide defitive answers about performance. 
guideposts that raise important questions about why thigs are the way they are and 
how they might be better. Ths is particularly so if the data are presented regularly 
and in a manner that allows for comparative assessment--both of an organiztion 
performance over time and of its performance vis-a-vis that of other like 
organtions. 
In the business world, managers, investors, and others have long relied on 
performance indicators in assessing a corporation s profitabilty. Indeed, the 
Securities and Exchange Commission (SEC) has identifed a long list of such 
indicators and has mandated that any publicly traded corporation provide quarterly 
data on them. The data address sales per share, earngs per share, percent return 
on equity, debt-to-equity ratio, and many other performance-related measures. 
In the public sector, where objectives tend to be more vared and less precisely 
defied, performance indicators have been much less commonly used. Yet, in recent 
years, in response to widespread concern about governental performance, they have 
been gaing  Ths is apparent in the fields of education and 
increased attention. 
health cae, where major effort are underway to improve the capacity to measure 
It is also apparent in the Chief Financial Offcers Act of 
and track performance. 
1990, which among other things calls for Federal agencies to provide for "the 
" as part of an integrated accounting and 
systematic measurement of performance
financial management system. 
Thus far, State medical boards, which are responsible for the licensure and disciplie 
of physician, have not made much use of performance indicators. Some movement 
in that direction, however, appears to be underway. In the fall of 1990, the 
Federation of State Medical Boards (FSMB), with support from the United States 
Public Health Servce (PHS), intiated a project to develop a self-assessment 
intruent 
for the boards.  At about the same time, the Citizen Advocacy Center 
which provides support to public members of professional licensing boards, issued a 
draft set of indicators that could be used for evaluating medical boards.  More 
recently, in a May 1991 legislative proposal addressing medical liabilty and 
malpractice problems, the White House called for State medical boards to collect 
and issue a range of performance-related data. 
These initiatives are in accord with a recommendation we made in an 
August 1990 report entitled "State Medical Boards and Medica Discipline  6 In 
(OEI-01-89-00560). that report we called upon both the FSMB and the PHS to 
support the development of quantitative indicators that could contribute to 
assessment of board performance. Both parties supported the recommendation. 
PUROSE 
Though this report we seek to contnoute to the further development and use of 
performance indicators for State medical boards. In so doing, we address only those 
board responsibilties concerning medical disciplie, the sphere in which most of our 
prior work has been concentrated. Similar attention, we believe, is warranted for 
those responsibilties concernng medical licensure. 
MEODOLOY 
Instead of proposing specific ratios and percentages that might be used as indicators 
we identif 20 basic questions that could provide the basis for such ratios and 
indicators (see appendix B). We take this approach because it focuses attention on 
the kid of information that could provide the foundation for developing quantitative 
, indicators.

We pose questions that concern three different facets of the boards' discipliar

responsibilties: (1) the detection of aleged violations, (2) the review of alleged

he resolution of caes. The questions are straightforward ones 
violations, and (3) 

that are likely to be of interest to those associated with boards and to relevant 
outsiders, such as governors, State legislatures, and the public. They emerge
priar 
from our prior work in the field and from our review of an insightful study 
conducted recently by the Virginia Department of Health Professions. 
, we then determne the extent to which answers are 
For each of the 20 questions
avaiable in anual  For the 36 boards that we 
reports on the State medical boards. 
found produce such report,9 we review the most recent report and indicate whether 
, both for the most recent year and for prior years. 
or not the answers are available
We focus on anual reports because of their regular issuance and their public nature.
Lie the anual reports of corporations conformg to SEC requirements, they 
represent what ca be a visible and important means of accountabilty to key 
constituencies. 
In the followig pages, we start out with an overvew of the States havig annual 
report and of the content of those reports. We then present the State-by-State data 
for each of the 20 questions, grouped in the 3 categories noted above. We close 
with a few concluding observations.  STATE MEDICAL  REPORTS
BOARS  WI ANAL 

In an important recent document, an expert panel convened by the Federation of 
State Medical Boards (FSMB) indicated what it regarded to be the vital elements of 
ll 
a modem State medical board. Among these was the issuing of an annual report. 
Each year, the panel noted, a board should submit to the governor
, the legislature 
and the public Ita formal report summariing its licensing and discipliary activity for 
"12 It then specifed  mium 
should be 
that year. 14 categories of data that at a 
included in the report. Many of them correspond to questions we pose in the 
following pages. 
Compared with the vision set forth by the FSMB panel, the current reality is quite 
diferent. Most strng is that the District of Columbia (hereafter referred to as a 
State) and 14 States stil do not produce an annual report (table 1), and they include 
two of the most populous States in the countr--New Jersey and Ohio. Both of these 
States reguarly compile reports namg the physicians who have been disciplied and 
cite the discipliary actions taken against them but do not issue yearly statistical 
summares in the reports. 

The 36 report that are issued vary greatly. They range from a single-page listing of 
data on various actions taken by a board to a more than 300-page document 
including little summary data but detailed descriptions of the fidings and conclusions 
on cases brought before the board. Some are wrtten and organized to reach a 
general audience; others are presented as technica pieces intended for a limited 
audience. 
Some of the report offer background information on the board and explanations of 
some of the activities undertaken durig the year. Few provide any analysis of the 
data s implications for the performance of a board. 
Overall, the report do not provide many answers to our 20 questions. Two of the 
questions. 
36 report, in fact, answer none of the questions at all. The others seldom provide 
trend data and tyically offer past-
year data that are responsive to only a few of the
Many and perhaps most of the State boards do have computeried data bases that 
could provide many more answers to the questions than those that are presented in 
the annual reports. Some even prepare summaries of these data bases, which they 
use for their own information and/or to respond to inquies made of them.  ;': %:=:?:~::~~~~~~~~~:~;~ ~~ ~;~;~'~;.:.  ~:~:~ ~.~:.:~:~; .;:;~ ~~~ . :::~/~. ~ . .; :  . .: .:; ::: . '. '.:' :.;:/. :. "::''  .)~: ~':  '~':~:~':\~:~ : ~::~:~/~;~': ~::~::. ~~~~~~~~~~' ' :"' ~~~~~~~:"~:. :;:: ~:!~:. ~:~:~:~. ~::;.'.  ~;~. ~. : \;. ~,.:(~: ~:;/  ~~~
Table 
STATE  MEDICAL BOARS WITH ANAL  REPORTS 
state 
f:1'  oo  : :e  kJil1? J:\  t :  l!)  IJ5; I:;;;  ; .0. 
' Y 
i.:i;  r..  :?=r  ::r  ;: i 
"t' :tr  : r 
lf1r. 
L::..  :i: 
!::)V 
J3:'  :l;It!?  B21:Jfi 
iI: 
k::  ITY:;(  t:..;;  :-r;;q!.  t:;;l ;rZ:  \;:t1'  \:\ IrC  rF: 
trI  :ttt r .  :r: :ri  !f.:  k:.  :I1  ;Tr:;:  :1. 
Key: An "X" in the columb ein dicates that an annl reprt providing informtion on the activities of the
State meical bord has  issue in 198 or thereafter.

Source: State meical bords as reprted to the Office of Inspetor Genral.
 DETECTON OF ATJ,RGED VIOIATIONS

In ths fist set of questions, we direct attention to the identifcation of physicians 
who may warrant discipliary action. We 
focus on two key variables: complaints 
and caes. 
Complaits, as we and the boards commonly use the term, are broadly defied as 
possible cases brought to the board' s attention by outside sources. They involve 
claims of alleged wrongdoing submitted by consumers or others. They also involve 
referrals (sometimes mandated) made by hospitals, law enforcement agencies 
professional associations, malpractice insurers, and others.1 Thus, by the term 
complait," we refer to external sources, of all kids, that brig 
possible cases to the 
attention of the boards. 
Because all complaints do not and perhaps should not lead 
to formal investigations 
we distinguish them from cases that boards have actually opened for investigation. 
Ths  although not necessary, smaller than that of 
universe of cases is most liely, 
complaints. It ca be larger since cases can be opened through proactive internal 
efforts of the boards as well as though complaints from external parties. 
In this section we pose 8 questions and review the extent to which the 36 anual 
reports. provide answers to them. The fist two questions address the number of 
complaits received and the number of cases opened; the next two ask if inormation 
is provided that compares these totals to the number of 
licensed physicians in the 
State. Such inormation ca be more useful than the absolute numbers in assessing 
changes occurrg over time or differences among State boards. 
The last four questions introduce two additional varables: complait source and 
complait tye. The former we discussed above; the latter distinguishes among 
various kids of alegations, such as inappropriate prescnbing, crial misconduct 
drgs. In reviewig data on the  , the reader 
or self-abuse of  tye of complaints
should recogne that upon investigation the grounds for possible board action can 
dier from the nature of the complaint that initiated the process. 
The followig tables indicate that the reports are much more 
liely to present data 
on complaits than on cases opened for investigation. The most complete data 
concern the absolute number of complaints, with 29 of the 36 report presenting 
such data for the past year and 12 for prior years as well. Data on complaints per 
licensed physician in the State, by complaint source, and by complaint tye are 
almost completely lackig. 
In regard to caes opened for investigation . only 16 of the report offer such 
information for the past year and 6 for previous years. No reports provide the 
information on a per-licensed-physician basis, two do so on the basis of complaint 
source, and four do so on the basis of complaint tye.  Question

HOW  COMPLAINTS  THE  STATE  KEDICAL  BOAR RECEIVED? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
colLl  latest amul reprt issue 
Key: An "X" in the first  indicates informtion is provide in the 
1989 or thereafter. An "X" in the secon colLl indicates informtion is provide for previou year(s). 
Source: State meical bords as reported to the Office of Inspetor Genral.  Question 
HOW  CASES  HAS  THE  BOAR OPENED  FOR  INVSTIGATION? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
Key: An "X" in the first colUl indicates informtion is provide in the latest annl reprt issue in 
198 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s). 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question 
HOW  COMPLAINTS  PER  LICENSEE  THE  BOAR  RECEIVED? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
Key: An "X" in the first colur indicates informtion is provide in the latest amul reprt issue in 
1989 or thereafter. An "X" in the secon colur indicates informtion is provide for previou year(s). 
Source: State meical bords as reprted to the 
Office of Inspetor Genral.  Question 
HOW  CASES  PER LICENSEE  THE  BOAR  OPENED? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
Key: An "X" in the first colUl indicates information is provide in the latest annl reprt issue in 
1989 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s). 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question

HOW  COMPLAINTS  FROM EACH COMPLAINT SOURCE

HAS THE BOAR RECEIVED?

state  Past  Year  Data  Provided  Trend  Data  Provided

Key: An "X" in the first colUl indicates information is provide in the latest annl reprt issue in 
198 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s).
Am the "  laint sources" that might be idetified are conslmrs, other licenees, hospitals, meical
societies 
, etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question

MA 
HOW  CASES  FROM EACH COMPLAXNT SOURCE

HAS  THE BOAR OPENED?

state  Past  Year  Data  Provided  Trend  Data  Provided

colUl  latest annl 
Key: An OX" in the first  indicates informtion is provide in the  reprt issue in
198 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s).
Am the "  laint sources" that might be idetified are conunrs, other licenee, hospitals, meical
societies
, etc. 
Source: State meical boards as reprted to the Office of Inspetor Genral.  Question 
BOW 	 COMPLAINTS OF EACH TYPE 
THE BOAR RECEIVED? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
Key: An "X" in the first colll indicates informtion is provide in the latest amual reprt issue in 
198 or thereafter. An "X" in the secon colll indicates informtion is provide for previou year(s).
Am the ItypS" of cCllaints that might be idetified are gross nel igene, incCltene, inappropriate
prescribing/treatmet , sexual miscont 
, self abue of drugs or alcohol , etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question 
MA 
HOW  CASES OF EACH TYPE 
HA THE BOAR OPENED? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
colua  latest amul reprt issue 
Key: An "X" in the first  indicates informtion is provide in the 
1989 or thereafter. An "X" in the secon colua indicates informtion is provide for previou year(s).
Am the "typs" of 
cases that might be idetified are gross nel igene, incCltene, inappropiate 
prescribing/treatment , self abue of drugs or alcohol , sexual miscont, etc. 
Source: State meical 
boards as reprted to the Office of Inspetor Genral.  AT J .  GED VIOIATIONS 
REVIW OF 

We frame this second category of  obtaiing,

questions around the process of 
assessing, and acting upon inormation concerng physicians who may have

committed a violation. We focus on one vital and relatively easy to measure

variable: time.

We ask how long the process takes, once a cae is opened, to reach two critical 
points: the completion of an investigation and the resolution of the board's action 
involvig a physician under investigation. That resolution may take the form of the 
closing of a case, a discipliary action, or a nondiscipliar educational action. 
We recogne that the review process involves many other important considerations 
but we regard time as a good initial performance indicator that can help 
identif and 
generate follow-up actions that can improve the process. IT the amount of time it 
. takes a board to conduct an investigation or resolve actions is increasing or is high 
relative to that of other boards, it is important to fid out why this is so. The 
resultant inquir and explanations might well identif weaknesses in how a board 
prioritizes caes, in the adequacy of its resources, in the trainig 
and/or capabilty of 
its investigative staff, and the like. It may also identif problems outside the board, 
such as delays in the offce of the State attorney, that slow down the process and 
have to address if a board is to expedite its review process. 
1hat State offcials 
It is also important to recognize that if a board' s review time is decreasing and/or is 
less than that of other boards, there may be explanatory factors that 
stil raise 
concerns about the effectiveness of the process. It may be, for instance, that a board 
is able to process cases relatively quickly because it avoids complex cases involvig 
the adequacy of medica care rendered and concentrates on caes 
that involve less 
har 
patient  but are easier to process. Thus, we add two questions that address 
processing time in relation to the tye of case involved. 
Unfortnately, the report are almost totally lackig in inormation that could lead to 
the kid of inquir noted above. For the four questions posed, only three report 
provide any inormation at all. Another report (Caliorna) notes in passing that the 
review process, from complaint to resolution, takes about 2 years but offers no 
further detais on the point.  Question

HOW LONG, ON AVERAGE, HAS IT TAKN FROK TH OPENING

A CASE TO THE COMPLETION OF AN INVSTIGATION? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
Key: An "X" in the fi rst colum indicates informtion is provide in the latest annl reprt issue
198 or thereafter. An "X" in the secon colum indicates informtion is provide for previou year(s). 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question  '10

HA IT 
HOW LONG, ON AVERAGE,  TAKEN FROK THE OPENING

OF A CASE TO THE COKPLETION OF AN INVSTIGATION,

FOR EACH TYPE OF CASE?

state  Past  Year  Data  Provided  Trend  Data  Provided 
Key: An "X" in the first colLn indicates informtion is provide in the latest amul reprt issue in 
secon colLn indicates informtion is provide for previou year(s).
1989 or thereafter. An "X" in the 
Am  tene
the IItypS" of cases that might be idetified are gross nel igene, inc  , inappropriate 
prescribing/treatmet , self abue of drugs or alcohol, sexual miscont, etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question  '11 
HOW  LONG, ON AVERAGE, HAS IT TAKEN FROM THE OPENING 
OF A CASE TO THE RESOLUTION OF ACTION? 
state  Past  Year  Data  Prov ided  Trend  Data  Provided 
in the latest amul reprt issue in 
Key: An "X" in the first colum indicates informtion is provide 
1989 or thereafter. An "X" in the secon colur indicates informtion is provide for previou year(s). 
"Resolution of action" is the final bord action on the case. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question  #12 
HOW LONG,  ON AVERAGE, HAS IT TAKEN FROM THE OPENING 
A CASE TO THE RESOLUTION OF ACTION, 
FOR EACH TYPE OF CASE? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
colUl  latest annl 
Key: An "X" in the first  indicates informtion is provide in the  reprt issue 
1989 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s). 
"Resolution of action" is the final bord action on the case. Am the "typs" of cases that might be 
idetified are gross neligene, incDqtene, inappropriate prescribing/treatmet, self abuse of drugs or 
alcohol , sexual miscont, etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  REOLUTON OF CASES

In this fial category, we emphasize two additional varables: discipliary actions and

nondisciplinary educational actions. By disciplinary actions, we refer to those license 
revocations, suspensions, probations, reprimands, fies, or other such actions intended 
to penalie a physician for a given violation. By nondiscipliary educational actions 
we refer to those actions that do not 
involve a discipliar order but are intended to 
help a physician improv  his or her practice of medicine. They might, for instance 
involve a medical counselig session with board-associated physicians. 
and controversial indicator of board 
Discipliary actions are the most widely used 
performance. The American Association of Retired Persons, in a 
1987 report 
asserted that the simplest way to determine how well a board is performng is to 
identif how many discipliary actions it is takig. 
But others maintain that such an 
indicator is a poor one on the grounds that it can lead to distorted perceptions of
board performance and can encourage a system of quotas. 
We recogne that a singular and simplistic use of discipliary actions in assessing 
board performance can be dysfunctional. It is for that reason that we complement 
them in this report with the other variables identifed earlier and with the strictly 
educational interventions some boards direct to physicians. By regularly issuing data 
concerng these variables, boards ca faciltate balanced and comprehensive 
assessments of their performance. 
A fial question we introduce has to do with how a board action is taken rather than 
with the action itself. It addresses the number of caes settled through consent 
agreements rather than through evidentiary heargs. Some feel that consent 
agreements are appropriate approaches that enable boards to carr out their 
responsibilties to the public more quickly. Others argue that they can lead to 
disciplinar actions that are too lenient and that can impede action against the same 
physician in another State in which he or she may be licensed. For both sides, and 
for those who have no preconceived view of the matter, the question, if answered 
can help frame considerations in light of recent realties and lead to useful follow-up 
questions relatig consent agreements to source of complaints and tye of cases. 
The report provide more information on discipliar actions than on any other 
variable identifed. Thirt of them indicate the number of such actions taken in the 
past year and 27 distinguish those actions by  prior years, 14 indicate total 
tye. For 
discipliar actions and 10 identify them by tye. 
Among the remainng questions, ten reports offer some information on consent 
agreements, four on disciplinary actions by  , and two on educational 
tye of case
actions. For four questions, those concerng actions per licensee and actions by 
complait source, none of the report provides any answers at all.  Question  '13

MA 
HOW  CASES OPENED FOR INVSTIGATION HAVE: (A) BEEN CLOSED 
WITHOUT ACTION, (B) RESULTED IN DISCIPLINAY ACTION, AN 
(C) RESULTED IN NONDISCIPLINAY EDUCATIONAL ACTION? 
state 
the latest annl reprt
Key: An "X" in the past year CPr) colum indicates informtion is provide in 
issue in 1989 or thereafter. An "X" in the tren data (TD) colum indiicanttese nin formtion is provide for
previou yearCs). "Discipl inary action" are official bord action  to pel ize a licenee. 
"Nonisc;pl inary edationl action" are official board action not associated with any discipl inary action
inten 
against a licenee and  to edate a licenee on som matter involving the practice of meicine. 
Source: State meical boards as reprted to the Office of Inspetor Genral.  Question  '14 
MA 
HOW  DISCIPLINARY ACTIONS PER

LICENSEE HAVE BEEN TAXN?

state  Past  Year  Data  Provided  Trend  Data  Provided

latest amul reprt issue
Key: An "X" in the first colum indicates informtion is provide in the 
198 or thereafter. An "X" in the secon colum indicates informtion is provide for previou year(s). 
inten 
"Discipl inary actions" are official board action  to pel ize a licenee. 
Source: State meical bords as reprted to the Office of Inspector Genral.  Question  '15

MA 
HOW  NONDISCIPLINARY EDUCATIONAL ACTIONS

PER LICENSEE HAVE BEEN TAKN? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
colUl  latest amul reprt issue in 
Key: An "X" in the first  indicates informtion is provide in the 
1989 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s).
"Noniscipl inary edcationl action" are official bord action not associated with any discipl inary action 
inten 
against a licenee and  to edate a licenee on som matter involving the practice of meicine. 
Source: State meical boards as reprted to the Office of Inspetor Genral.  Question  '16 
MA 
HOW  DZSCZPLZNAY ACTZONS FROK EACH 
COKPLAZNT SOURCE HAVE BEEN TAKN? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
colUl  latest amul reprt issue 
Key: An "X" in the first  indicates informtion is provide in the 
198 or thereafter. An "X" in the secon colUl indicates informtion is provide for previou year(s). 
"Disciplinary action" are official bord action intened to pelize a licenee. Am the "  laint 
conumrs, other licenees, hospitals, meical societies, etc. 
sources" that might be idetified are 
Source: State meical bords as reprted to the Office of Inspetor Genral.  estion  '17 
MA 
HOW  NONDISCIPLIHAY EDUCATIONAL ACTIONS  FROM EACH

COMPLAINT SOURCE HAVE BEEN TAKN?

state  Past  Year  Data  Provided  Trend  Data  Provided

annl 
Key: An "X" in the first colum indicates informtion is provided in the latest  report issue in 
1989 or thereafter. An "X" in the secon colum indicates informtion is provide for previous year(s). 
"Noni scipl inary educationinl atcetinon " are official bord action not associated with any disciplinary action 
against a licenee and are  to edate a licenee on som matter involving the practice of meicine.
Am the "cCJlaint sources" that might be idetified are conllrs, other licenee, hospitals, meical
societies, etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question  '18

MA 
HOW  DISCIPLINAY ACTIONS FOR EACH

TYPE OF CASE HAVE BEEN TAKN? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
annl 
Key: An "X" in the first colum indicates informtion is provide in the latest  reprt issue in 
1''D98is coirp lt ihnearreya aftcetiro. nA"n  a"rXe "o finfi cthiae ls beocaornd  caoctluiomns i nidnictaetnes  itnof opreml tiizoen  ias  lpircoevnideee f.o rA pmrev tihoeu  y"teyapr"(s )o.f 
cases that might be idetified are gross neligene, incoqtene, inappropriate prescribing/treatmet,
self abue of  , sexual miscont 
drugs or alcohol , etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question  '1.9 
MA 
HOW  DISCIPLINARY ACTIONS  EACH

TYPE HAVE BEEN TAKN?

state  Past  Year  Data  Provided  Trend  Data  Provided

colur  latest amul reprt issue 
Key: An "X" in the first  indicates informtion is provide in the 
"1D98i9s coipr l tinhearreya fAtcetri.o nA"n  a"rXe"  oifnf itchiea ls ebcoornd  caocltuiro ni nidnictaetnes  tinof opreml tiizoen  ais  lpircoevnideee f.o Ar pmre vtihoeu  "yteyapr"(s )o.f
discipl inary action taken against licenees are licene revocation, licene suspeion, licene 
, fine
probtion, reprimand , etc. 
Source: State meical bords as reprted to the Office of Inspetor Genral.  Question  '20

HOW  CASES  HAVE BEEN SETTLED THROUGH A CONSENT AGREEMENT 
OPPOSED TO AN EVIDENTIARY HEARING? 
state  Past  Year  Data  Provided  Trend  Data  Provided 
col\J  latest amul report issue in
Key: An "X" in the first  indicates informtion is provide in the 
198 or thereafter. An "X" in the secon colll indicates informtion is provide for previou year(s). 
Source: State meical bords as reprted to the Office of Inspetor Genral.  CONCLUDING OBSERVATIONS

The major value of performance indicators is the opportunity they can provide for 
comparative assessments. For instance, identifng the number of complaints a board 
has received from consumers in 1990 is likely to mean little in itself. But, if that 
number is compared with parallel numbers for prior years, then a reviewer can 
determine if there has been a change and, if so, ask why. Simarly, if a board' 
performance on some indicator is compared with  , a 
lie boards in other States
reviewer can see if that board' s performance differs from the others and, if so, seek 
to learn the reasons. The Virgia Department of Health Professions, in its recent 
report, addressed such interstate comparsons as, follows: 
It is clearly in the interest of individual regulatory boards to compare 
their enforcement experience with the experience of boards governing 
lie professions in other States. Once these comparsons are made-
using a consistent nomenclature and standardized measures of 
enforcement activity--boards may wish to examie the regulatory 
envionment (regulatory provisions, resources, and organtional 
signcat
structure) in which they operate for an 
explanation of 
diferences in performance. If structural impediments to public 
protection and the fair and equitable treatment of licensees are 
identifed, efforts should be made to remove those impedimentsP 
In the middle of the above quotation is a term that is of great consequence. to any 
comparative effort: "a consistent nomenclature." Establihig such a nomenclature 
obviously would be far more diffcult across States than withi them, but in either 
case it is vital if comparative data are to be relied upon. When comparisons are 
made, whether they involve earngs per share of corporations or complaints to 
medical boards per licensed physician, definitions must be consistent if they are to 
useful. 
The specific questions that would carr the most comparative value is a matter that 
warrants further examiation and experientation. We View the ones we have posed 
as preliminary suggestions meant to stimulate inquir and momentum toward the 
establihment and use of performance indicators. Yet, given the minial 
performance-related data we found in the annual reports, it may be that little 
momentum is liely as long as the collection and issuance of such data are voluntary. 
For that reason, we suggest that State legislatures mandate that State medical boards 
establish a series of performance indicators and provide data on each of them in 
annual report made available to governmental offcials and the public. Toward this 
end, the National Conference of State Legislatures, the National Governors 
Association, the Council of State Governents, the Federation of State Medical 
Boards and the United States Public Health Servce can play 
valuable supportive 
roles as agents for the exchange of ideas and inormation.  , "
APPENDIX A

ENDNOTES 
In the educational field, the White House and the National Governors 
Association have established a panel to gauge the nation s progress toward six 
gmutuoallya agreleds up.on  education goals. Toward that end, one of the tasks of 
the panel is to select precise measures and to assess progress in reaching the
In the health care field, the movement to establish medica practice guidelies
follows the same direction. Of particular note are the effort of the Agency 
for Health Care Policy and. Research in the United States Public Health 
Servce to establish Medicare practice guidelines addressing such areas as 
cataracts, prostate disease, and pain management. 
See H.R. 5687- , Section 902  Authority and Functions of Agency Chief 
Financial Offcers. 
The project involves identifg the most significant indicators of 
medical board performance. See Federation of State Medica Boards 
FSMB Newsletter. no. 36 (September 1990). 
See Health Advocacy Servces, America Association of Retied 
Citizen Advocacy News. vol. 2, no. 3 (4th quarer, 199). 
Persons, 
The proposed legislation is entitled the "Health Cae Liabilty Reform and 
Qualty of Care Improvement Act of 1991." It provides fiancial incentives for 
ca 
the States to  out tort and quality of care reforms. 
mentioned in the text we have issued the 
In adqition to the report already 
following report concerng State medical boards: "Medica Licensure and 
Disciplie: An Overvew, (P-01-8600), June 1986; "State Medica Boards 
and Medica Discipline: A State-by-State Review " (OEI-01-89-00562), August 
1990; and "Quality Assurance Activities of Medical Licensure Authorities 
the United States and Caada" (OEI-01-89-00561), Februar 1991. 
Virgiia Department of Health Professions, the Board of Health 
Professions  A Review of Enforcement and. Discipline in the 
Department of Health Professions. June 199. 
We wrote to each State medica board, requesting a copy of its most 
did not respond, we 
recent annual report. For those boards that 
followed up with a call to determine if, in fact, the board or some State  agency produced an annual report on the board' s activities. We 
defied the reports as being documents produced annually that were 
made available to the State legislature, governor s offce, and the 
public. We did not include internal data summaries or periodic 
summares or studies. Also, we did not require that the data provided 
taken against physicians as opposed to 
in the reports distinguish actions 
other licensees under the board's jursdiction. Such a distinction would 
obviously be helpful for intra-State assessments and essential for inter
state comparisons. 
In computing and presenting the data, we stressed accuracy and precision. 
We conducted two checks of all the data, one by ourselves and one by the 
boards involved. Stil, with the meanig of data categories in annual report 
sometimes unclear, it is possible that there are some 
mistakes or omissions. 
Thee States, Minnesota, Virgia, and Wisconsin, produce a report 
every 2 years. We include them in our review. 
10.	 As we note subsequently in the text, we recogne that many boards 
have access to much more inormation on their performance than is 
presented in an annual report. Our focus here is not on the 
inormation available or periodicaly presented, but on that regularly 
made available in annual reports directed to external audiences. 
11.	 Elements of a Modern State Medical Board: A Proposal. August 1989. 
12.	 Ibid., p. 15. 
13.	 Diferent boards may define complaints and other variables addressed 
in this report in different ways. Over time, especially if boards were to 
engage in interstate comparisons, consistency in these defitions 
lited  determg
important. Our intent in this report: however, is  to 
whether or not an annual report 
includes data (in the form of yearly 
summaries) addressing the variables posed in the questions, even if the 
variables are defied somewhat diferently in dierent States. 
14.	 For example, many boards now seek to identif "markers" of possible 
violations by requiring that physicians, as part of their license renewal 
applications, submit information on various actions or conditions that 
would be of concern to the boards. Such information leads, in some 
cases, to the opening of an investigation. 
15.	 It may also be desirable to include cases that did not involve a 
dicipliary action but did involve a referral to an impaired physicians 
program. We did not include such cases in our review because our 
A  prior investigations indicated that such referrals are often not treated as

an offcial, documented board action. 
16.	 American Association of Retired Persons  Effective Physician Oversight: 
Prescription for Medical Licensing Board Reform. 1987. 
17.	 A Review of Enforcement and Discipline in the Department of Health 
Professions. 
p. 6. 
A 
 APPENDIX 
mE 1WNI 
QUESTIONS 
How many complaints has the State medical board received?

How many cases has the board opened for investigation?

How many complaints per licensee has the board received?

How many cases per licensee has the board opened?

How many complaints from each complaint source has the board received?

How many cases. from each complaint source has the board opened?

How many complaints of each tye has the board received?

How many cases of each  the board opened?

tye has 
How long, on average, has it taken from the opening of a case to the

completion of an investigation? 
10.	 How long, on average, has it taken from the openig of a cae to the 
completion of an investigation for each tye of case? 
11.	 How long, on average, has it taken from the opening of a case to the 
resolution of action?

12.	 How long, on average, has it taken from the openig of a cae to the 
resolution of action for each tye of case? 
13.	 How many caes opened for investigation have been closed without action 
, and resulted in nondisciplinar educational 
resulted in disciplinary action
action? 
14.	 How many discipliar actions per licensee have been taken? 
15.	 How many non discipliar educational actions per licensee have been taken? 
16.	 How many discipliary actions from each complait source have been taken?  source 
17.  How many nondisciplinary educational actions from each complaint 
have been taken? 
18.  How many discipliary actions for each tye of cae have been taken? 
taken? 
19.  How many disciplinary actions of each tye have been 
20.  How many cases have been settled through a consent agreement as opposed 
to an evidentiary hearing?