J Oral Maxillofac 48:1249.
Surg
1990
Putting Your Reputation
in the Bank
Confidentiality of the data is another key issue. Numerous organizations have already expressed fear that the information may be misused. A statement issued by the American Medical Association noted its concern that the reports may be used as indications of incompetency rather than for their conceived purpose, as a basis for further investigation, and that it is essential that data bank information be kept strictly confidential to insure a rigorous and aggressive peer review process. This is especially important in view of the fact that settlement of a malpractice claim may occur for a variety of reasons that do not necessarily reflect negatively on the professional competence or conduct of the doctor. Those involved in the review process need to be constantly aware that settlement of a claim should not be construed to mean, a priori, that malpractice has occurred. A problem that perhaps affects dentistry more than it does medicine relates to the refunding of fees. Currently, a fee that is directly refunded in response to a patient’s written complaint must be reported to the data bank as a malpractice action. Because dental society peer review mechanisms frequently employ such mediation between the doctor and the patient as a prompt and inexpensive way to resolve disputes, a reporting requirement jeopardizes the system and could result in an unnecessary increase in litigation. The American Dental Association is seeking legislative relief in exempting fee refunds from the reporting mechanism, and we need to strongly support this effort. Although other problems with the data bank regulations require correction, such as the need to report a voluntary restriction of privileges while this matter is still under investigation or the possibility of one incident resulting in multiple reports, basically, the plan should be helpful in controlling those who have engaged in unprofessional behavior. The system, however, also has the obligation to see that the doctor is protected from unfair practices by agencies who provide and use these data. Through such efforts, and the continued cooperation of those in a position to bring about the necessary changes, both the public and the profession should ultimately benefit from the new plan.
After numerous delays, the National Practitioner Data Bank finally became operational in September of this year. This data bank is designed to restrict the ability of physicians and dentists to move their practices from one state to another without the discovery of previous substandard professional performance. The associated legislation also encourages greater peer review by providing immunity from private damages for professional review bodies of hospitals and other health care entities, as well as persons serving on or otherwise assisting such bodies. The data bank is intended to augment, not replace, the traditional forms of credentials review by providing yet another resource to assist state licensing boards, hospitals, and other health care entities in conducting independent investigations of the qualifications of health care practitioners they seek to license, hire, or grant clinical privileges. To accomplish this, the data bank will collect information on all payments made on behalf of physicians and dentists as a result of malpractice claims; disciplinary actions related to licensure taken by state boards; actions by hospitals that adversely affect clinical privileges and that involve professional incompetence or inappropriate conduct; and adverse actions by professional societies regarding membership following formal peer review of the practitioner’s professional competence or behavior. As with many legislative actions, although the basic philosophy of the data bank is a good one, numerous questions already have been raised about the interpretation or implementation of certain regulations, and it is clear that some already require modification or revision. For example, as currently written, malpractice claims of any size will have to be reported. The tendency of insurance carriers to settle small nuisance claims as a cost-saving measure, regardless of the justification for the complaint, could lead to some practitioners being penalized unjustly. This would be particularly true for those whose insurance policies contain a provision that permits the carrier to decide whether it is worth defending against the claim in a court of law. Because it will require Congress to create a reporting threshold based on the amount of the award, this matter needs to be brought to the attention of our legislators.
DANIEL M. LASKIN
1249
Surg
1990
Putting Your Reputation
in the Bank
Confidentiality of the data is another key issue. Numerous organizations have already expressed fear that the information may be misused. A statement issued by the American Medical Association noted its concern that the reports may be used as indications of incompetency rather than for their conceived purpose, as a basis for further investigation, and that it is essential that data bank information be kept strictly confidential to insure a rigorous and aggressive peer review process. This is especially important in view of the fact that settlement of a malpractice claim may occur for a variety of reasons that do not necessarily reflect negatively on the professional competence or conduct of the doctor. Those involved in the review process need to be constantly aware that settlement of a claim should not be construed to mean, a priori, that malpractice has occurred. A problem that perhaps affects dentistry more than it does medicine relates to the refunding of fees. Currently, a fee that is directly refunded in response to a patient’s written complaint must be reported to the data bank as a malpractice action. Because dental society peer review mechanisms frequently employ such mediation between the doctor and the patient as a prompt and inexpensive way to resolve disputes, a reporting requirement jeopardizes the system and could result in an unnecessary increase in litigation. The American Dental Association is seeking legislative relief in exempting fee refunds from the reporting mechanism, and we need to strongly support this effort. Although other problems with the data bank regulations require correction, such as the need to report a voluntary restriction of privileges while this matter is still under investigation or the possibility of one incident resulting in multiple reports, basically, the plan should be helpful in controlling those who have engaged in unprofessional behavior. The system, however, also has the obligation to see that the doctor is protected from unfair practices by agencies who provide and use these data. Through such efforts, and the continued cooperation of those in a position to bring about the necessary changes, both the public and the profession should ultimately benefit from the new plan.
After numerous delays, the National Practitioner Data Bank finally became operational in September of this year. This data bank is designed to restrict the ability of physicians and dentists to move their practices from one state to another without the discovery of previous substandard professional performance. The associated legislation also encourages greater peer review by providing immunity from private damages for professional review bodies of hospitals and other health care entities, as well as persons serving on or otherwise assisting such bodies. The data bank is intended to augment, not replace, the traditional forms of credentials review by providing yet another resource to assist state licensing boards, hospitals, and other health care entities in conducting independent investigations of the qualifications of health care practitioners they seek to license, hire, or grant clinical privileges. To accomplish this, the data bank will collect information on all payments made on behalf of physicians and dentists as a result of malpractice claims; disciplinary actions related to licensure taken by state boards; actions by hospitals that adversely affect clinical privileges and that involve professional incompetence or inappropriate conduct; and adverse actions by professional societies regarding membership following formal peer review of the practitioner’s professional competence or behavior. As with many legislative actions, although the basic philosophy of the data bank is a good one, numerous questions already have been raised about the interpretation or implementation of certain regulations, and it is clear that some already require modification or revision. For example, as currently written, malpractice claims of any size will have to be reported. The tendency of insurance carriers to settle small nuisance claims as a cost-saving measure, regardless of the justification for the complaint, could lead to some practitioners being penalized unjustly. This would be particularly true for those whose insurance policies contain a provision that permits the carrier to decide whether it is worth defending against the claim in a court of law. Because it will require Congress to create a reporting threshold based on the amount of the award, this matter needs to be brought to the attention of our legislators.
DANIEL M. LASKIN
1249
