The Washington Post yesterday erroneously reported that the Public Citizen Health Research Group said doctors should know that seven manufacturers have had high recalls rates for faulty intraocular lenses -- lenses implanted in cataract victims. The health Group actually said that consumers and doctors should know the names of the seven companies making the so-called anterior chamber lens, because it has a higher complication rate than other types, according to the Food and Drug Administration, and provides, on the average, poorer correction than other types of lenses or cataract surgery. The group listed the seven firms, and the records of some, as: "CILCO Inc. (recall in 1978 for mislabeling), Intermedics (recall in 1978-79 due to a high rate of . . . sterile pus in the front part of the eye), IOLAB (recall in 1978 because of over 100 cases of glaucoma, bleeding in the eye and inflammation . . .), McGhan Medical, Precision Cosmet. Rayner & Keller (imported by Coburn Optical) and Surgidex (recall in 1977 because of over 600 cases of glaucoma, bleeding and inflammation)."
For the past five years, the U.S. government has been quietly financing compilation of great quantities of data on how well individual physicians and hospitals are doing their jobs under the Medicaid and Medicare programs.
With the United States footing the bill, now about $145 million each year, local committees of physicians called PSRO (Professional Standard Review Organizations) have been reviewing records to see if the hospitals are keeping people in too long, if doctors are performing too many operations or using questionable types of treatment; if death rates are unusual. The findings are used to recommend improvements in local procedures and to disallow Medicare and Medicade payments for unjustified practices.
Now a fight is developing over whether this information should also be made available to the public.
On one side is Dr. Sidney Wolfe, the medical gadfly who heads Ralph Nader's Public Citizen Health Research Group, (HRG). He wants statistical information about individual doctors and hospitals made public, while patients' names would remain secret.
On the other side are HEW, medical professionals and the National Capital Medical Foundation of Washington, D.C. They believe that publishing information about individual doctors would create a climate of fear and concealment among physicians and wreck the PSRO system, leaving no way to check on local medical practices except what one Capitol Hill health specialist called "an army" of federal bureaucrats.
Two years ago Wolfe sued the government and the National Capital Medical Foundation, which is the PSRO for the District of Columbia.
To the surprise of many, he won. U.S. District Judge Gerhard Gesell ruled that information sought by Wolfe should be made available under the Freedom of Information Act and the 1972 law setting out the PSRO structure.
The decision has been appealed to a higher federal court and the information won't be delivered until that appeal is decided. HEW, meanwhile, has told Congress it wants the 1972 law changed so it can continue to withhold release of the information as long as it chooses. The Senate Finance Committee has recommended such a change.
Wolfe contends release of the doctor and hospital statistics would greatly strengthen beneficial competition in the medical market place.
One recent study, said Wolfe, "showed that post-surgical mortality is between two and three times higher in some hospitals than in others, even after statistically adjusting for difference in patient age, medical condition and other characteristics.
"We can conceive of no rationale which justifies withholding from consumers with particular medical problems data indicating that they have almost a three times greater statistical probability of post-surgical survival in one hospital than another."
However, the Department of Health, Education and Welfare and the PSROs have refused to yield the information sought by Wolfe.
They believe that if statistics on deaths of patients, number of operations and like were published for individually named physicians, it could mislead the public, which knows little about medical matters. They say it would cause doctors to drop out of the review organizations for fear of inviting groundless malpractice suits and unjustified public criticism of colleagues whose practices they review.
The result, said Leonard Schaeffer, who heads HEW's Health Care Financing Administration, would be the destruction of the best mechanism that now exists for ending questionable hospital and doctor practices and getting them to improve their levels of services.
"Unrestricted disclosure of PSRO data," he told the health subcommittee of the House Interstate and Foreign Commerce Committee last month, "weakens the effectiveness of the program and raises the very real possibility that physicians may terminate memebers in PSROs." He said PSROs "must be allowed to function in an environment which guarantees freedom of expression to member reviewers" (the doctors serving on the review committees).
Dr. Helen Smits, who oversees PSROs for HEW, said the real purpose of the PSRO program is to improve medical practice and not to search out wrongdoing and punish those responsible for it.
She said in an interview that disclosure of information about physicians would have a "dampening effect on doctors' frankness with each other and on relatively smooth, quick-acting peer review" of medical practices.
"This is gong to work best if it [stays] private. It's not in human nature to be perfectly frank about people you like if you know it's going to be printed ," Smits said. One of the biggest risks feared by doctors is malpractice suits. "Nothing would make an ambulance-chasing lawyer happier than to have some of this stuff."
She said it seems clear that the whole review system would become paralyzed if every doctor knew that information could be printed. HEW has already received a heavy volume of letters from doctors saying they'd refuse to serve on the review committees if Wolfe's changes were made.
She said doctors fear indiscriminate charges and revelations.
A Capitol Hill health specialist said, "If the PSRO system collapsed, you'd need an army of federal doctors to go into each hospital to do the same thing."
Smits said HEW doesn't object to publication of certain information requested by Wolfe -- namely, statistics on hospital stays and admissions for certain types of illenesses, nor does it object to releasing "profiles" of hospital practices and identifying the individual hospitals.
But she said HEW does object to releasing similar statistics naming individual doctors and to releasing "medical care evaluations," which are indepth studies of how well a hospital and the doctors using it do in handling a specific category of problems -- for example, hysterectomies. These studies would reveal matters such as average length of stay, number of operations, number of recoveries, etc.
She said regulations being drafted by HEW would reflect the information-release position she outlined.
The Senate Finance Committee, meanwhile has drafted a provision and tacked it onto a minor bill, HR 934, to forbid release of information by named doctors, but it would allow HEW to order release of some of the hospital information if HEW chose. So far, the House hasn't taken action except to conduct hearings.
The PSROs basically are local doctor committees that review hospital admission and release practices, lengths of stays and the performance of doctors in the Medicaid and medicare programs. They don't maintain big batteries of physicians who work solely for them. Instead, they use trained nurses to gather initial statistics and then pay private doctors using a hospital an hourly fee to make evaluations of various practices by their colleagues. All PSRO costs are paid by the federal government.
Dr. Norman Fuller, is executive director of the National Capital Medical Foundation (NCMF), the private non-profit PSRO for the District of Columbia which Wolfe and HRG sued. Some 2,200 physicians are members of the NCMF and participate in its governance through a board of directors now headed by Dr. Robert L. Hackney.
It reviews admissions and discharges and other matters at 13 hospitals, 9 nursing homes, 3 specialty hospitals and some other offices and institutions participating in the Medicare and Medicaid programs in D.C. "We check every Medicare and Medicaid patient -- either on the day of admission of afterwards," Fuller said.
NCMF President Hackney said in an interview, "There are several reasons why physicians have a negative feeling" about Wolfe's proposals."Physicians with bad mortality rates often are those who usually are referred patients who are dying. Obviously the death rates will be high. Publishing figures will make it look like they're bad physicians."
Dr. Wolfe, summarizing the HRG position, said he believes publication of information by named hospital and doctor wouldn't seriously hurt peer review and moreover, "If a doctor is ripping people off or doing a lousy job there's no real public interest in withholding the information."
The Senate Finance Committee, like HEW, takes a different view. "Should all data acquired be disseminated without safe guards, recruitment of physicians to perform PSRO functions would become increasingly difficult," language prepared for the committee report on HR 934 asserts.
Judge Gesell rejected this theory, but the ball is now in the hands of Congress and the U.S. appeals court.