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So ... Why Aren't Health Plans Using the Data Bank, Anyway?

MANAGED CARE July 2001. © MediMedia USA
News and Commentary

So ... Why Aren't Health Plans Using the Data Bank, Anyway?

MANAGED CARE July 2001. ©MediMedia USA

Everyone is afraid of being sued. Health plans don't want to be sued by their physicians. Neither plans nor doctors want to be sued by patients. And so America's zeal for litigation has emasculated one tool meant to provide accountability in health care: the hated National Practitioner Data Bank.

The Office of the Inspector General's revelation that 84 percent of HMOs did not once report evidence of an adverse event — malpractice settlement, licensure action, etc. — to the Data Bank during the '90s triggered a flood of excuses. HMO insiders told the New York Times that liability concerns lead some plans to strike quiet deals with physicians: Quit the provider panel in exchange for not being reported. Plans depend on hospitals to do the dirty work — though 60 percent of hospitals, also fearful of suits because it's hard to prove individual responsibility, made no reports.

In a USA Today essay, American Association of Health Plans President Karen Ignagni wrote that HMOs are doing what they think is the law — reporting physicians to state boards. The OIG said health plans' reliance on contracted physicians, instead of salaried doctors, may have contributed to the fact that they made only 715 reports during the '90s. Using the Institute of Medicine's 1999 report on safety as a gauge, at least 440,000 people died in hospitals over that period because of medical errors.