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When Florida began considering physician profiling legislation in 1996 (see story, p. 69), the Florida Medical Association (FMA) in Tallahassee knew it had to be in on the drafting. "It was the best way to ensure that both consumers and physicians were protected," explains FMA president Richard Bagby, MD, FACR.
Because Massachusetts already had a law on the books, Bagby decided to use the expertise of his counterpart there in coming up with a sensible position and a strategy for working with state legislators. He arranged for Massachusetts Medical Society president Joe Heyman, MD, FACOG, and one of the law’s strongest critics, Barbara Rockett, MD, to fly down to Florida and speak to FMA members.
Florida doctors realized profiling could be good for them, says Bagby. "In an era of managed care, doctors often don’t know about the physicians to whom they refer patients. It made them more willing to accept profiling." But they had to be sure that what was presented to the public was both useful to consumers and fair to the doctors.
Bagby asked his members to provide input into what the profiles should include. Their list included 11 headings:
This should include medical school attended; year of graduation; graduate medical education; board certifications, recertifications, or eligibility; hospitals where the physician has staff privileges; faculty appointments; other medical education (optional); and professional and community service activities such as membership in medical associations or specialty societies.
This does not have to be a comprehensive list, but rather a representative sample.
3. Participation in health plans.
The doctors wanted to include a notation that physician participation in PPOs, HMOs, Medicaid, and Medicare may change and that the best information comes directly from the physician’s office.
4. Practice information.
Office hours, locations, group affiliations, acceptance of new patients, and focus of practice should be in this section.
5. Languages spoken.
This statement should outline that the data provided in the profile should not be used to judge a doctor’s competency or the quality of care a patient can expect.
7. Disciplinary history.
Actions taken by the Florida Board of Medicine, the Florida Board of Osteopathic Medicine, and/or actions taken by boards from other states within a specified period of time would be included under this heading.
8. Criminal convictions.
Doctors recommended that this be limited to felonies and serious misdemeanors.
9. Liability history.
The membership suggested that this be limited to judgments and settlements that led to disciplinary actions by one of the boards mentioned above, comparative data on other physicians in comparable specialties and practice settings, a limit of five years of history, and a disclaimer that this information does not necessarily reflect the quality of care provided by the doctor.
10. Physician statement.
This would give the doctor a chance to explain any positive or negative data in the profile.
11. Additional information.
Nonmedical education, such as an MBA, awards, or community service activities could go in this section. The doctors also recommended that this information be updated regularly.
Once the list was completed, however, Florida faced a problem: Its general meeting was scheduled for late spring after the bill was to come before the legislators.
"Massachusetts had the same problem," Bagby says. But the FMA bypassed the problem by seeking the input of the county medical societies. Their members voted on what was prepared and approved it with the proviso that such a plan apply to all licensed professions.
The legislation was passed May 2 and goes into effect January 1, 1999, for medical doctors and doctors of osteopathy. Other licensed health care professionals will be included as of January 1, 2000.
Although some of the doctors’ wishes didn’t make it into the final bill other licensed professions don’t face profiling until 2000 Bagby says he thinks the full involvement of the FMA membership has served physicians well. "We spoke our message and were heard."
• Richard Bagby, MD, FACR, president, Florida Medical Association, Tallahassee, FL. Telephone: (904) 224-6496.
• Joe Heyman, MD, FACOG, president, Massachusetts Medical Society, Boston. Telephone: (617) 893-4610.
• Leonard Morse, MD, chief medical officer, Greater New Bedford Community Health Center, New Bedford, MA. Telephone: (508) 992-6553.
• Barbara Rockett, MD, surgeon, Brookline, MA. Telephone: (617) 969-6110.