Going high profile: Medical boards push transparency

More than a decade ago, Massachusetts became the first state to mandate its medical board to post physician profiles online. With the click of a mouse, patients could find a physician's hospital affiliations, hospital and medical board disciplinary actions, medical malpractice payments and other data.

The Massachusetts board, like others across the nation, had long collected much of the information, which was available to those who called or wrote. But the state's idea to display physician data on an easily accessible Web site was novel in 1996. Many physicians were skeptical in the beginning, resulting in a heated debate of how to post information that was useful to the public and fair to doctors.

In the end, though, both sides appear to be happy with the system in place.

"It has worked out reasonably well," said Massachusetts Medical Society President Bruce Auerbach, MD. "It is an opportunity for patients to step up and see information such as where a physician has received training, whether they are board certified, whether they have malpractice suits against them and whether or not the suit falls in what one might expect in that specialty."

Russell Aims, spokesman for the Massachusetts Board of Registration in Medicine, said the program has been a success from the board's perspective as well. There are about 6.5 million visits to the 31,000 physician profiles in a given year. "It is information you could have gotten, but now it's all in one place and easier to access," he said.

Today, 65 of 70 boards in the United States put physician profiles online, according to the Federation of State Medical Boards. But what is included in those profiles varies. Most states post licensure status and disciplinary history on the Web sites they've created. The more detailed sites, though, include items such as medical malpractice information and criminal convictions, with only 16 and 17 boards, respectively, posting that information.

It makes online physician profiles an evolving arena, especially as consumers continue to demand more and more about doctors.

"Boards have recognized their outreach roles to help patients make informed decisions," said Lisa A. Robin, FSMB senior vice president for member services. "There is still variation [on what each state does online], and we believe it will continue to evolve."

And the debate between physicians and medical boards continues to focus on what is appropriate to place on those Web sites.

"Safeguarding the millions of patients in our health care system is one of the highest priorities for physicians," AMA President-elect J. James Rohack, MD, said in a statement. "Disseminating raw, unsynthesized legal data does not advance patient safety. Instead, well-balanced, complete data should be available in a context that is both truthful and easy to understand for patients."

In many states, before information was posted online, physicians were concerned that patients would not be able to put material such as medical malpractice data into context. They also worried that inaccurate data could be listed or that their names might be connected to a medical board investigation prematurely.

Seeking balance

As physicians have worked with many state medical boards and legislatures to make sure that the postings were fair, accurate and in context, their earlier fears have not been realized. In South Carolina, the debate was over when the board made disciplinary actions public.

"We worked hard with the board of examiners and state Legislature to make sure patients had useful information, while at the same time provide privacy for physicians. We have a fair system," said Gerald E. Harmon, MD, past president of the South Carolina Medical Assn.

In Illinois, physicians were concerned about the implications of the state posting medical malpractice judgment and settlement amounts, as well as any felony convictions and Class A misdemeanors from the past five years.

"The good news is that it's not as ominous as I thought it would be," said Shastri Swaminathan, MD, Illinois State Medical Society president. "So far, I haven't heard an outcry from physicians."

In Georgia in 2003, a bill introduced to the Legislature called for posting any malpractice action or claim. Physicians helped get it changed so that only medical malpractice verdicts exceeding $100,000 and from the past 10 years are listed. The state also displays certain settlements against physicians.

"We didn't want to see frivolous claims posted," said David Cook, Medical Assn. of Georgia executive director.

In New Jersey, physicians helped ensure that medical liability information was put in context. The state board's Web site tells a visitor how many malpractice payments the physician has made, how many physicians are in that physician's specialty, and how many physicians in that specialty made malpractice payments in the past five years. It also shows how many total malpractice payments there were in the specialty and whether the physician is below average, average or above average compared with other physicians in the specialty.

"I have not heard any complaints by doctors that the information has been faulty or misleading," said Larry Downs, general counsel for the Medical Society of New Jersey.

But North Carolina is in the thick of the debate.

The state's medical board posts basic information, such as whether a doctor is licensed, where he or she went to medical school and an office address. But more may be added to its Web site in 2009, including medical liability payments, medical board information from other states, and hospital privilege suspensions and revocations.

Earlier this year, the North Carolina Medical Board, after public comment, made revisions to a proposal to expand the profiles. For example, the board decided it would display medical malpractice payments greater than $25,000 instead of posting all payments. However, because enough people objected to the revised rules, the General Assembly, which passed legislation calling for expanded information, will have the opportunity to review the rules and consider changes when it reconvenes in late January 2009.

North Carolina Medical Society officials -- who support consumer access to meaningful data about physicians, including certain medical malpractice information -- would like to see some changes.

They are concerned that the board wants to show medical malpractice payments dating back to October 2007, when the General Assembly passed the law calling for the board to post more information.

NCMS supports posting medical malpractice payments that occur after the final rule would take effect.

"Nobody on earth knew what the final makeup of the rules would be," said Stephen Keene, general counsel for the NCMS. "Without any doubt ... it would influence settlement agreements, especially those with confidentiality clauses."

Officials also are concerned, among other things, that the Web site would include all malpractice payments, not just the ones in which the board determined there was substandard care.

"The board should use its expertise to inform the public about which cases involve bad medical care and should not put up cases where there wasn't bad medical care," Keene said. "We believe it is appropriate for the public to be told about meaningful medical malpractice information."

But state medical board officials do not believe that would be fair. The board sends private letters of concern to physicians it does not believe need to be publicly reprimanded.

Consequently, "if we do what the medical society asks -- if we post [cases] of public action and private letters of concern and don't post the rest of them -- the public can figure out which doctors got the private letters of concern," said Thom Mansfield, legal department director for the North Carolina Medical Board.

Mansfield said the board has worked hard on the proposed rule, listening to all sides.

"Is it perfect? Hard to say," he said. "Does it strike a good balance? We believe so."

Making more available

While strides have been made to make information more readily available, some argue that additional steps are needed.

A 2006 report by consumer advocacy group Public Citizen ranked how state boards' Web sites fared in disclosing physician information in eight categories, including board disciplinary action, malpractice data and criminal convictions. The median score for state MD and DO boards was 42.2 of a possible 100. New Jersey scored the highest at 83.7 points.

"More states are doing a better job ... but only a minority of states posted criminal convictions and hospital disciplinary jobs," said Sidney M. Wolfe, MD, director of Public Citizen's Health Research Group. "It's a shame from the standpoint of patients that they are putting up so few details."

That is likely to change. The trend toward transparency is expected to continue.

"People expect transparency," said David Swankin, president and CEO of the Washington, D.C.-based Citizen Advocacy Center, which offers training and research for members of health care regulatory, credentialing and governing boards. "It's a good thing to see. For too long we drew the balance the wrong way."