Report Highlights Inconsistency Between Hospital and State Licensing Actions Against Physicians

A March 2011 report by Public Citizen, a non-profit consumer advocacy group, found that out of the 5,887 physicians in the National Practitioner Data Bank (NPDB) "with one or more clinical privilege actions -- revocation or restriction of their clinical privileges," more than half had no state licensing actions taken against them. The report questions whether or not state medical boards are receiving reports of hospital actions and whether or not the medical boards are properly responding to reports of discipline through appropriate action at the state level.

Public Citizen examined clinical privilege reports, medical malpractice payment reports, as well as the NPDB Public Use File, which does not disclose the identity of the practitioners queried. It found that many physicians who had clinical privilege disciplinary actions related to incidents such as incompetence, sexual misconduct, fraud, malpractice, and being deemed "an immediate threat to health and safety" had reports in the NPDB, bit had no state licensure action taken against them.

The report issued several recommendations. First, it encouraged states to strengthen medical board oversight to improve performance in taking action against disciplined physicians. It also called on the boards to work with the Health Resources and Services Administration (HRSA) to ensure that action is taken against the physicians in the NPDB who curerntly have clinical privilege reports but no state licensure action. Finally, the report called on the Department of Health and Human Services Office of the Inspector General to resume investigations of state medical board effectiveness. This oversight review was last performed 18 years ago.

In response to the report, Humayun Chaudhry, D.O., president and CEO Federation of State Medical Boards (FSMB) stated:

“While not every hospital action requires a medical license disciplinary action, many states have indicated that there is significant under-reporting to them of hospital sanctions. Recognizing this, several state medical boards and the Federation of State Medical Boards have been collaborating with HRSA since 2010 to explore ways of cross-referencing information contained in the National Practitioner Data Bank with the information the boards have in order to create a more effective reporting system. State medical and osteopathic boards do the best they can with the resources they have, but they cannot take an action against a physician if they are unaware of the problem. The report by Public Citizen is a reminder of the value of collaboration among many different groups (e.g., physicians, hospitals, state boards, federal agencies and the public) and the need for them to seek ways to work together in protecting the public and promoting quality health care.”

To read the Public Citizen report, click here:
http://www.citizen.org/documents/1937.pdf


Sources: Public Citizen, FSMB

FSMB Discusses the Collection of Physician Data under the Proposed MOL Framework

In April, the Federation of State Medical Boards (FSMB) released a report outlining the implementation of the Maintenance of Licensure (MOL) program. Many NAMSS members have already started to ask questions about how the MOL may affect the credentialing process.

Frances Cain, Director of Post-Licensure Services for FSMB has provided the following information. Feel free to leave any questions or comments that you may have for FSMB and Ms. Cain in the blog's comment field.

Although FSMB has adopted a framework for MOL, there are still some questions as to how state medical boards might implement MOL and how it may look “on the ground” for physicians. The FSMB has recently established a MOL Implementation Group, which has been charged to create a template to assist state medical boards in implementing MOL. This will include a more detailed exposition of the options for complying with MOL that fall outside of Board-certification. FSMB hopes to have this report out for comment in the fall, and will send a copy to NAMSS.

There have been many questions about the types of data physicians may have to collect in order to comply with MOL and how that information may be used by the state medical board. To date, all of the committees and workgroups that FSMB has convened to explore the issue of MOL and to develop the MOL framework that was adopted by our House of Delegates last month have all been very sensitive to the concerns of physicians about the privacy of their data. As such, the final report and MOL recommendations that were adopted by FSMB as policy includes the following statement:

“Practice performance data collected and used by physicians to comply with MOL requirements should not be reported to state medical boards. Third party attestation of collection and use of such data (as part of a professional development program) will satisfy reporting requirements.”

Therefore, under the proposed MOL framework, physicians could be able to comply with MOL through participation in the very same activities in which they are already participating (e.g., CME, procedural hospital privileging, 360 evaluations, medical professional society/organization clinical assessment/practice improvement programs, CMS and other similar institutional-based measures). Participation in these activities could be verified by the state medical board through third-party attestation, rather than direct reporting of the data. A more detailed listing of proposed activities that physicians could use to comply with each of the three components of MOL are provided in the MOL Advisory Group report (see pages 79-80 of the adopted MOL policy report at http://www.fsmb.org/pdf/mol-board-report-1003.pdf).

To use the example of CME, under MOL a state medical board may choose to require that CME used for license renewal be related to the physician’s area of practice; however, the board could use the same system it currently has in place (i.e., a random audit of a small group of licensees) to verify physicians’ compliance with those requirements.

Although central to the FSMB’s proposed MOL framework is the concept that each state medical board would adopt its own guidelines for applying MOL, through our Implementation Group and future pilot projects with individual state medical boards, we would hope to develop recommendations that will be consistent across state lines. MOL will be an “evolutionary” process and will require much thought such that it provides public protection while paying attention to the concerns of physicians and the resources available to state medical boards.

FSMB encourages input from all stakeholders as we proceed with this task.

FSMB Report Shows 6% Increase in Disciplinary Actions Against Physicians

According to the Federation of State Medical Board's (FSMB) Summary of 2009 Board Actions report, 342 more disciplinary actions were taken against physicians in 2009 than in 2008, representing a 6% increase.

For the report, the FSMB monitored the actions of 70 state medical and osteopathic boards. FSMB assessed the Composite Action Index (CAI) of each state board, which is an average of the number of disciplinary actions taken by the board and the total number of licensed physicians in the state.

The New Hampshire and South Dakota medical boards were shown to have the highest increase in their CAIs between 2008 and 2009. The Florida Board of Osteopathic Medicine and the South Carolina Board of Medical Examiners had the largest decrease between 2008 and 2009.

To read the FSMB report, click here:
http://www.fsmb.org/pdf/2009-summary-board-actions.pdf


Sources: FSMB, Modern Healthcare

Closed Residency Programs Records Are Available

A service from the Federation of State Medical Boards (FSMB) offers to permanently store the records of residency programs that have closed. The FSMB also offers to house medical staff files from closed hospitals. Upon request, the FSMB will verify a physician’s training or medical staff affiliation from one of these programs.

According to the Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and URAC, verification of a physician’s credentials from one of these closed programs by the FSMB meets the primary source verification requirements of each of those organizations. To date, nearly 50 closed programs have sent their records to the FSMB.

The FSMB provides a centralized, uniform process for health care entities to obtain a verified, primary source record of physicians and physician assistants’ core medical credentials. For more information, please go to www.fsmb.org/fcvs_closedprograms.html or contact Nicole Lloyd at nlloyd@fsmb.org or (817) 868-5084.