Information on incompetent doctors is included in a computer system known as the National Practitioner Data Bank, created by Congress to protect patients against doctors who move from state to state without disclosing that they have been censured or disciplined in some way for providing poor care. The inspector general's explanation was stark. Carmella Bocchino, vice president of the American Association of Health Plans, said many HMOs apparently did not realize that they were required to tell the government when doctors were disciplined for incompetence or misconduct. Sometimes, some HMO executives said, they work out quiet deals with inept doctors under which the doctor resigns from a health plan, and in return the health plan promises not to file a report with the federal databank. Sen. Ron Wyden, D-Ore., the author of the 1986 law that created the National Practitioner Data Bank, said the low level of reporting was unacceptable.
Health plans ought to do more than just pay lip service to the goal of quality in health care.
The databank is for the use of hospital and other health care providers and federal law prohibits it from disclosing information on a specific doctor to the general public. Federal investigators said HMOs and hospitals frequently consulted the national databank to check on doctors' qualifications, but rarely contributed any information of their own. In the last 10 years, managed care organizations submitted more than 8 million inquiries, accounting for about half of all queries. Discussion of the databank is part of a larger debate over medical errors and the quality of care. Many HMOs have adopted clinical guidelines to ensure that doctors follow the best practices for diagnosing or treating specific conditions.