Department of Health and Human Servces


OFFICE OF


INSPECTOR GENERA


PERFORMANCE INDICATORS, ANNUAL


REPORTS, AND STATE MEDICAL


DISCIPLINE: A STATE-BY-STATE


REVIEW


VIC. 

"0 

Richard P. Kusserow 

INSPECTOR GENERA 

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 

Thir-thee Sta meal board is an an report oth is biel report 

th report provi few anser to th 20 quns Tho aner none of 

qutins at al 
 Th oth rarel offer tren data an tyal prvi pa-yea data

th resnd to onl a few of the qutins. 

Th report are mo li to anser quns conc th nuer of complain 

receied an diciliry actins ta In regard to complain 29 reprt provi su data for th pa year and 12 for prr years as wel for dipli actins 

th CO"esndg nuer are 30 and 14. Th lack of informtin concerg th proesg ti for cases un rev par stg. For th three quns posed on th matt onl thee report

provi an informtin at all 

CONCLUDING OBSERVATIONS


Th major val of peormnce inators is th opport th can provi to make 

compaatie asests and to raise quns on how peorme can be improved 

We sugges th State lelatues mand th th boa esblih a ser of 

peonn inatrs and provi data on th in an reprt Toward th en 

th Natna Conferene of State Lelatues, th Natina Goverrs Astir; Coun of Sta Goerts, th Fedn of State Medal Boards an th Uni 

State Puli Hea Sere can pla valble supporte role as agen for exge of id 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 

do not provide defitive answers about performance. But they can serve as useful 

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 increased attention. Ths is apparent in the fields of education and 

health cae, where major effort are underway to improve the capacity to measure 

and track performance. It is also apparent in the Chief Financial Offcers Act of 

1990, which among other things calls for Federal agencies to provide for "the 

systematic measurement of performance" as part of an integrated accounting and 

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 
(OEI-01-89-00560).6 In 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 

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. 

violations, and (3) 


For each of the 20 questions, we then determne the extent to which answers are 

avaiable in anual reports on the State medical boards. For the 36 boards that we 

found produce such report,9 we review the most recent report and indicate whether 

or not the answers are available, both for the most recent year and for prior years. 

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 BOARS WI ANAL 
 REPORTS

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 

a modem State medical board.ll 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 

that year."12 It then specifed 14 categories of data that at a mium should be 

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 

36 report, in fact, answer none of the questions at all. The others seldom provide 

trend data and tyically offer past- questions. 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. 
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STATE MEDICAL BOARS WITH ANAL REPORTS 

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Key: An "X" in the colum indicates that an annl reprt providing informtion on the activities of the

State meical bord has be 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 universe of cases is most liely, although not necessary, smaller than that of 

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 

or self-abuse of drgs. In reviewig data on the tye of complaints, the reader 

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 

Key: An "X" in the first colLl indicates informtion is provide in the latest amul reprt issue 

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


HOW MA CASES FROM EACH COMPLAXNT SOURCE


HAS THE BOAR OPENED?


state Past Year Data Provided Trend Data Provided


Key: An OX" 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). 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 , self abue of drugs or alcohol , sexual miscont , etc. 

Source: State meical bords as reprted to the Office of Inspetor Genral. 
Question 

HOW MA CASES OF EACH TYPE 

HA THE BOAR OPENED? 

state Past Year Data Provided Trend Data Provided 

Key: An "X" in the first colua indicates informtion is provide in the latest amul reprt issue 

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. 
REVIW OF 
 AT J . GED VIOIATIONS 

We frame this second category of questions around the process of obtaiing,


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 

1hat State offcials have to address if a board is to expedite its review process. 

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 

patient har 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


HOW LONG, ON AVERAGE, HA IT 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 

1989 or thereafter. An "X" in the secon colLn indicates informtion is provide for previou year(s). Am the IItypS" of cases that might be idetified are gross nel igene, inc tene, 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 

Key: An "X" in the first colum 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). 

"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 

Key: An "X" in the first colUl indicates informtion is provide in the latest annl 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. 

Discipliary actions are the most widely used and controversial indicator of board 

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 tye. For prior years, 14 indicate total 

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 tye of case, and two on educational 

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


HOW MA CASES OPENED FOR INVSTIGATION HAVE: (A) BEEN CLOSED 

WITHOUT ACTION, (B) RESULTED IN DISCIPLINAY ACTION, AN 

(C) RESULTED IN NONDISCIPLINAY EDUCATIONAL ACTION? 

state 

Key: An "X" in the past year CPr) colum indicates informtion is provide in the latest annl reprt issue in 1989 or thereafter. An "X" in the tren data (TD) colum indicates informtion is provide for

previou yearCs). "Discipl inary action" are official bord action inten to pel ize a licenee. 

"Nonisc;pl inary edationl action" are official board action not associated with any discipl inary action against a licenee and inten 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 

HOW MA DISCIPLINARY ACTIONS PER


LICENSEE HAVE BEEN TAXN?


state Past Year Data Provided Trend Data Provided


Key: An "X" in the first colum indicates informtion is provide in the latest amul reprt issue 198 or thereafter. An "X" in the secon colum indicates informtion is provide for previou year(s). 

"Discipl inary actions" are official board action inten to pel ize a licenee. 

Source: State meical bords as reprted to the Office of Inspector Genral. 
Question '15


HOW MA NONDISCIPLINARY EDUCATIONAL ACTIONS


PER LICENSEE HAVE BEEN TAKN? 

state Past Year Data Provided Trend Data Provided 

Key: An "X" in the first colUl indicates informtion is provide in the latest amul reprt issue in 

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 

against a licenee and inten 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 

HOW MA DZSCZPLZNAY ACTZONS FROK EACH 

COKPLAZNT SOURCE HAVE BEEN TAKN? 

state Past Year Data Provided Trend Data Provided 

Key: An "X" in the first colUl indicates informtion is provide in the latest amul reprt issue 

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 

sources" that might be idetified are conumrs, other licenees, hospitals, meical societies, etc. 

Source: State meical bords as reprted to the Office of Inspetor Genral. 
estion '17 

HOW MA NONDISCIPLIHAY EDUCATIONAL ACTIONS FROM EACH


COMPLAINT SOURCE HAVE BEEN TAKN?


state Past Year Data Provided Trend Data Provided


Key: An "X" in the first colum indicates informtion is provided in the latest annl report issue in 

1989 or thereafter. An "X" in the secon colum indicates informtion is provide for previous year(s). 

"Noni scipl inary educationl action" are official bord action not associated with any disciplinary action 

against a licenee and are inten 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


HOW MA DISCIPLINAY ACTIONS FOR EACH


TYPE OF CASE HAVE BEEN TAKN? 

state Past Year Data Provided Trend Data Provided 

Key: An "X" in the first colum indicates informtion is provide in the latest annl reprt issue in 

198 or thereafter. An "X" in the secon colum indicates informtion is provide for previou year(s). ''Discipl inary action" are official board actions inten to pel ize a licenee. Am the "typ" of 

cases that might be idetified are gross neligene, incoqtene, 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 '1.9 

HOW MA DISCIPLINARY ACTIONS EACH


TYPE HAVE BEEN TAKN?


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 

1989 or thereafter. An "X" in the secon colur indicates informtion is provide for previou year(s). "Discipl inary Action" are official bord action inten to pel ize a licenee. Am the "typ" of

discipl inary action taken against licenees are licene revocation, licene suspeion, licene 

probtion, reprimand , fine , 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 

Key: An "X" in the first col\J indicates informtion is provide in the latest amul report issue in 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 lie boards in other States, a 

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 

structure) in which they operate for an explanation of signcat 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 

mutually agreed upon education goals. Toward that end, one of the tasks of 

the panel is to select precise measures and to assess progress in reaching the goals. 

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 Persons, Citizen Advocacy News. vol. 2, no. 3 (4th quarer, 199). 

The proposed legislation is entitled the "Health Cae Liabilty Reform and 

Qualty of Care Improvement Act of 1991." It provides fiancial incentives for 

the States to ca out tort and quality of care reforms. 

In adqition to the report already mentioned in the text we have issued the 

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 

recent annual report. For those boards that did not respond, we 

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 

in the reports distinguish actions taken against physicians as opposed to 

other licensees under the board's jursdiction. Such a distinction would 

obviously be helpful for intra-State assessments and essential for interstate 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 

important. Our intent in this report: however, is lited to determg 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 tye has the board opened?


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 

resulted in disciplinary action, and resulted in nondisciplinar educational 

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? 
17. How many nondisciplinary educational actions from each complaint source 

have been taken? 

18. How many discipliary actions for each tye of cae have been taken? 

19. How many disciplinary actions of each tye have been taken? 

20. How many cases have been settled through a consent agreement as opposed 

to an evidentiary hearing?