An inquiry by three senators into why HHS' inspector general's office has discontinued evaluations of state medical boards has led to questions about another issue: States using medical boards' financial reserves—money collected from physician license fees—to plug holes found elsewhere in their budgets.
Sens. Max Baucus (D-Mont.), Charles Grassley (R-Iowa), and Orrin Hatch (R-Utah) have sent a letter (PDF)
to HHS Inspector General Daniel Levinson requesting his office resume its past practice of evaluating state medical boards. The letter cited research by consumer advocacy group Public Citizen noting that serious disciplinary actions by state boards dropped by 20% between 2010 and 2004, and that state boards did not take action against 167 physicians whose hospital admitting privileges had been revoked after being deemed an “immediate threat to health or safety.”
“We met with Grassley's staff and we're pleased they're doing this, and we hope the inspector general will respond,” said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, noting that the evaluations started in 1981 and then the inspector general "just stopped doing them" 15 years ago.
“Most medical boards are doing a terrible job,” Wolfe added.
Wolfe noted that since board operations are financed through license fees, states cannot use budget problems as an excuse for poor performance. “It's a flow of money that acts independently of any financial crisis most states are in,” Wolfe said.
However, some states are dipping into medical board operating funds or cash reserves to plug holes that exist elsewhere in their budgets, he said.
Wolfe said he has testified against this practice in California and New Jersey, and—according to the Federation of State Medical Boards—it's also been done in Arizona, Colorado, New Mexico, Washington state and probably others as well.
“It's not an uncommon practice—unfortunately,” said Lisa Robin, chief advocacy officer for the medical board federation. “State boards should be adequately funded if we expect a robust regulatory environment.”
Robin said the federation would be happy to cooperate with the inspector general on any evaluation they might undertake, and she added that the federation has been working with HHS to get doctor disciplinary action information stored in its National Practitioner Data Bank more easily shared with state medical boards
. Robin said some hospitals will file reports with the NPDB but not their state board, so work is being done so reports can be filed with both simultaneously.
She also said that Public Citizen-provided material that was included in the senators' letter could be characterized as misleading.
“We don't know enough information about these physicians who had (hospital) privileges revoked and why boards didn't take action against them,” Robin said. She also explained how the senators' letter cites a December 2010 article discussing how the Connecticut Medical Examining Board doesn't take action against doctors practicing in the state who have been disciplined elsewhere, but what isn't mentioned is that the board didn't have the statutory authority to do so until now and how, at the time the cited article was published, legislation giving that authority was still pending.
Robin said the same is true in Missouri.
Robert Leach, executive director of the Minnesota Board of Medical Practice since 1995, also had complaints about how his organization was characterized in the senators' letter and by Public Citizen in the past.
For example, Leach said the Minnesota board has been criticized for not posting information on malpractice judgments and settlements, but he explained that they don't have the statutory authority to do. “If our state Legislature changes the law, we'd be more than happy to post,” he said.
Leach adds that the state has also dipped into the board's financial reserves—set aside for “extraordinarily extended cases”—and used it for deficits elsewhere in the state's general fund, and he said legislation is being crafted to prevent future occurrences.
“We object because it's another tax on healthcare professionals,” he said. “When their license fees go elsewhere in the budget, they're essentially paying taxes twice.”
For three straight years, Public Citizen has listed Minnesota 51st
in its ranking of the medicals boards from all 50 states and the District of Columbia. The rankings are based on a three-year average of federation data on “serious disciplinary actions,” which include license suspension and revocations.
Leach said Public Citizen doesn't count the board's remediation agreements with doctors, which are kept confidential and are used for cases in which there was no patient harm, a small number of patients were exposed to any potential risk and there was no sexual misconduct.
He added that the state has few remaining independent physicians, so most belong to systems where they are subject to internal peer review and, as a result, “Minnesota is world-famous for the quality of its healthcare.”
In the meantime, Leach said he would “absolutely welcome” an evaluation of his board by HHS' inspector general's office. “I'm anxious to see what comes out of this,” Leach said. “Hopefully, something positive.”