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PROs must tell patients of inquiry results

Some worry the federal court decision endangers the peer review process, but the ruling's full effect isn't clear yet.

By Tanya Albert, amednews staff. Aug. 6, 2001.

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When a Medicare patient or the patient's family complains about a physician's care, Medicare peer review organizations must tell them what the resulting investigation found, a federal court ruled in July.

Centers for Medicare & Medicaid Services regulations prohibit PROs from disclosing their findings to patients unless the physicians in question consent to it. But the court said those regulations are invalid because they conflict with a federal law that says PROs need to let the person who made the complaint know the investigation's outcome.

U.S. District Court for the District of Columbia Judge Ellen Segal Huvelle gave the Dept. of Health and Human Services 20 days to send a letter to PROs telling them that they must disclose investigation results to the person who initiated the complaint.

That's a concern for those who believe peer review needs to be kept confidential.

"It is one additional chink being placed in the protective wall that has always surrounded quality and peer review," said health lawyer Sheryl T. Dacso with Jenkens & Gilchrist's Houston office.

But it's still too soon to know how big the chink will be.

At press time, HHS had not decided whether it would appeal the decision and had not offered its interpretation of the ruling.

"A lot depends on what HHS says," said David Schulke, executive vice president of the American Health Quality Assn., which represents PROs. "Physicians are understandably very nervous about whether this will generate lawsuits." [...]