Limits to the Active Health Care Consumer

Question Everything
Image by dullhunk via Flickr

As health care consumers, we are being asked to become more active participants in our health care. We are admonished to exercise more, not smoke, wear seatbelts, use sunscreen—all of those individual risk and protective factors—as a way of reducing health care costs. We are asked to be more involved in patient safety—to ask our health care providers questions such as “How many times have you done this procedure?” And “Why do I need this treatment” (see AHRQ’s: Questions Are The Answer website.) And to take in a list of questions to ask your provider. AHRQ doesn’t tell you that all of these questions are a sure way to obtain the instant label of Problem Patient

We are asked to become more involved in health care quality, to report errors/concerns about providers, to shop for the highest quality hospital when we have the lead-time to do so. AHRQ tells us, “Do your homework before you chose a hospital.” Online tools for doing this homework include Medicare’s Hospital Compare and the Joint Commission’s Quality Check.

But how are consumers supposed to know if their doctor, nurse practitioner, dentist, or other health care providers are competent? This, of course, assumes that patients still have a choice of providers—a dwindling luxury with managed care and the fact that the really good providers aren’t taking new patients. Most people go by old-fashioned word-of-mouth, or the media equivalents: Doctors Score Card (really just a Yelp consumer rating of doctors) and HealthGrades. (supposedly more objective, risk-adjusted health outcomes data). Patients are generally good at assessing ingredients of quality of care by providers, such as interpersonal skills and hand washing—but not so good at assessing technical competence of providers.

Instead, consumers rely on others within the health care system to ensure ongoing competence of health care providers: peer reviews, professional organizations, and health professions regulatory systems. None of these are exactly transparent or accountable to the general public. Some states have started to provide accessible online searchable databases of doctors/other providers and their practice histories. Most of these are quite rudimentary and not very helpful. For instance, in Washington State, the site only provides the health care provider’s credential type and status, and whether or not they have had any disciplinary actions: yes/no. California has similarly limited consumer information on individual providers—however, their site does provide consumer information on collagen injections. Really. In contrast, Massachusetts on MyHealthCareOptions allows consumers access to information on individual provider’s malpractice claims, hospital and state licensing disciplinary actions, and criminal convictions. Plus it’s a very cool and user-friendly interface.

Then there is the federal/DHHS/HRSA National Practitioner Data Bank—established by Congress in 1986—which has as its mission “to protect the public by restricting the ability of unethical or incompetent practitioners to move from state to state without disclosure or discovery.” The Data Bank collects individual practitioner data on malpractice claims, and disciplinary actions from state licensing agencies, hospitals, health plans, the DEA, and professional organizations—and makes these data available to hospitals, state licensing agencies, and other health care entities—but not to consumers. And now not even to researchers or journalists.

Until this month, researchers and journalists had access to a public use file from the Data Bank, not to individual practitioner data. But this public use file was recently removed due to a complaint by a neurosurgeon in Kansas who was ‘outed’ by a journalist for having a significant malpractice history/never disciplined by the state. (see NYT article “Withdrawal of Database on Doctors Is Protested” Duff Wilson, 15 Sept 2011). The journalist got this information by being a good investigative journalist and not directly from the Data Bank. Journalism organizations, as well as consumer protection groups, have protested the removal of the Data Bank public use file. They point out that resources such as the Data Bank have informed investigative journalism reports on the serious shortcomings of our health regulatory system. These reports have had significant impact on promoting improvements in the system—including attempts to provide relevant practitioner practice information to consumers.

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