Minn.: You’re mis­taken

North Star State dis­misses dis­ci­pline rank­ing

Modern Healthcare - - The Week In Healthcare - An­dis Robeznieks

When it comes to state med­i­cal boards dis­ci­plin­ing doc­tors, the Pub­lic Ci­ti­zen Health Re­search Group con­cluded that Alaska does the best job and Min­nesota does the worst.

Not sur­pris­ingly, Robert Leach, ex­ec­u­tive di­rec­tor of the Min­nesota Board of Med­i­cal Prac­tice, dis­missed the Pub­lic Ci­ti­zen rank­ings.

“Min­nesota is world-renowned for the health­care it pro­vides,” Leach said. “ I al­ways ask peo­ple where they would rather go for health­care: Alaska or Min­nesota? Peo­ple from all over the world come to Min­nesota to get their health­care at the Mayo Clinic.”

Each year, Pub­lic Ci­ti­zen cre­ates its rank­ings by tak­ing a three-year av­er­age of the med­i­cal li­cense re­vo­ca­tions, sur­ren­ders, sus­pen­sions, pro­ba­tions and sus­pen­sions for each state com­piled by the Fed­er­a­tion of State Med­i­cal Boards, and di­vides that to­tal by the state’s physi­cian pop­u­la­tions to come up with a “se­ri­ous ac­tions per 1,000 physi­cians” rat­ing for each state and the District of Columbia. The fed­er­a­tion’s data were re­leased April 1 (April 5, p. 18).

Alaska had a 7.89 rat­ing for 2009, and— for the fourth-straight year, was ranked first. Min­nesota had a 1.07 rat­ing, and— for the sec­ond year in a row—fin­ished in 51st place.

“The method­ol­ogy is flawed in so many ways,” Leach said, adding that it was “sim­plis­tic” and didn’t take into ac­count the num­ber of com­plaints a board re­ceives and in­ves­ti­gates. “That fac­tor is left out of their equa­tion.”

Sid­ney Wolfe, di­rec­tor the Pub­lic Ci­ti­zen Health Re­search Group, said “it’s a given” that it’s a small frac­tion—even fewer than 1%—of doc­tors who are caus­ing prob­lems. “The ques­tion is not whether the prac­tice of medicine in a state is bet­ter or worse,” Wolfe ex­plained. “It’s whether the board is do­ing a good job of dis­ci­plin­ing the same small frac­tion of doc­tors.”

In this year’s re­port, Pub­lic Ci­ti­zen notes how Hawaii has gone from 51st place in 2003 to 10th place in 2009 and North Carolina went from 41st place to 12th place dur­ing the same pe­riod. “When you look at the num­bers and see a board go from do­ing a bad job to do­ing a good job, it isn’t be­cause there was a mass mi­gra­tion of bad doc­tors into the state,” Wolfe said.

In states with low rank­ings, Wolfe said one com­mon fac­tor is usu­ally hav­ing “the state leg­is­la­ture asleep at the wheel.”

Leach, on the other hand, said the states with higher rank­ings typ­i­cally are pop­u­lated by “large num­bers of physi­cians in pri­vate, solo prac­tices with an abil­ity to get into trou­ble.” In Min­nesota, he said there are prac­ti­cally no solo prac­tices left and that most physi­cians in the state are sub­ject to daily peer re­view.

He also men­tioned that Min­nesota’s board, which con­sists of 11 physi­cians and five non­physi­cian “pub­lic” mem­bers, is a “quasi in­de­pen­dent state agency” that re­ceives its fund­ing from li­cense fees and is not de­pen­dent on the state Leg­is­la­ture for fund­ing.

It also has the use of in­ves­ti­ga­tors from the state at­tor­ney gen­eral’s of­fice. Ac­cord­ing to Leach, this is a setup that most states envy. “They would love to have the sit­u­a­tion we have in Min­nesota,” he said.

The states fin­ish­ing just above Min­nesota were South Carolina, with a 1.09 se­ri­ous ac­tions per 1,000 physi­cians rat­ing in 2009; Wis­con­sin, at 1.59; New Hamp­shire, at 1.65; and Con­necti­cut, at 1.8.

States fin­ish­ing be­hind Alaska at the top of the list were North Dakota, with 6.01 se­ri­ous ac­tions per 1,000 physi­cians rat­ing; Ken­tucky, at 5.67; Ohio, at 5.43; and Ari­zona, at 5.2.

Pub­lic Ci­ti­zen also noted that Ohio was the only state among the 15 most-pop­u­lous near the top, while large states like Cal­i­for­nia and Florida con­tinue to be ranked near the bot­tom, this year com­ing in 41st and 44th place, re­spec­tively.

To im­prove doc­tor dis­ci­pline, Pub­lic Ci­ti­zen rec­om­mends, among other things, that med­i­cal boards con­duct proac­tive in­ves­ti­ga­tions in ad­di­tion to re­act­ing to com­plaints, rely on all avail­able data—such as Medi­care and Med­i­caid sanc­tions—and have in­de­pen­dence from state med­i­cal so­ci­eties.

Wolfe: “It isn’t be­cause there was a mass mi­gra­tion of bad” docs.

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