The present scheme for providing information to patients that
would presumably allow patients to minimize their own risks
involving the treatment by various doctors is not perfect, to
say the very least. Currently, state licensure boards and other
disciplinary bodies regulate the flow of physician quality
parameters. This type of information only reflects negative
findings once a review is initiated, which does not enable
patients to make informed decisions. However, the means by which
health care quality is assessed is changing.
What implications will the health information
revolution have for the health care regulatory framework? One
possible answer is that the health information revolutions
should prompt us to regulate less. A patient with access to
information about individual provider's quality of care, for
example, would have less need for state medical boards
assistance in rooting out poor quality providers . . .. A second
possible answer is that the health information revolution should
prompt us to regulate more. Information imperfections will
persist forever, so regulation can at least potentially benefit
some patients. Because information about quality is an input
into the regulation process, and technological innovation has
reduced the cost of such information, we can regulate more
cheaply than we once could. Kristin Madison, Regulating Health
Care Quality in an Information Age, 40 U.C. Davis L. Rev. 1577
(2007).
The question as to whether more openly
available information will best serve the interest of patients,
or whether this availability will afford a new and improved
means of effectively publicizing a sham peer review is not
clear. In a Utopian sense, if the actual quality of the
provider's services were available in an unbiased manner,
patients would indeed be armed with an effective tool to assist
them in finding the most suitable provider for their needs.
Unfortunately, the real world of kangaroo courts and sham
reviews destroys this ideal. The public is informed, of course,
in terms of what is reported to the National Practitioner Data
Bank and in the form of board orders. This does not insure the
information is factually correct, especially when the
individuals providing the information to the data banks have
immunity and may have pecuniary interests in the information
provided. Thus, the present form of providing information to the
public to improve the public safety and welfare is significantly
flawed.
A hypothetical patient that moves to a new
city may seek information as to which provider they should see
for a given need. In Utopia, the patient could find information
regarding providers with the highest ratings for various
services or conditions. Instead, in Real America, the patient
sees only the names of the providers who remain on staff at the
facility of choice without knowing who might be better for their
given need. The best provider, in fact, may not be listed due to
a sham review that removed that provider from the staff; hence,
the patient would never be aware of that provider. Perhaps, the
economic interests of those in control of the peer review
process came ahead of maintaining the best provider on the
staff. Perhaps, a negative report was generated against the
provider that would have best served the patient's needs, which
obviously places the provider on the DO NOT USE list for
services – to the average patient. The average person looking to
receive healthcare does not understand the intricacies of sham
peer review versus genuine reviews based on true competency and
safety concerns. This is Real America, not Utopia. Sadly, this
can and does happen.
Until an appropriately regulated Utopian
informational system becomes available, sham peer reviews will
continue. There is a solution. The Center for Peer Review
Justice can manage the sham peer review defense and help with
the abuse from the State Medical Boards.