Checking on your doctor? Even feds' database is flawed

A federal database meant to help patients learn more about physicians is full of massively flawed data – and no one seems able to explain why.

The errors highlight a disturbing reality: Not only do average people have trouble getting accurate information about doctors, but so does the federal government.

Even worse, the mistakes appear to open the door for less-scrupulous doctors to distance themselves from pasts that include medical board actions, lawsuits or even criminal charges, according to data and health-care experts interviewed by The Enquirer.

"Any automated and electronic system using the (federal database) could be corrupted," said Dayton native David Marsidi, who founded a company that compiles physician data for patients. "If you start out with bad data and you try to link everything from bad data, it's not going to be accurate."

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Here's what's happening:

Most physicians are legally required to get what's called a National Provider Identifier, a unique, 10-digit number assigned to them by the federal Centers for Medicare & Medicaid Services, or CMS. Patients can search those numbers in an online database, which also includes physicians' state license numbers.

It's those license numbers that are the problem: They're wrong in tens of thousands of cases, an Enquirer investigation has found.

What the mistakes could mean for consumers is tough to pinpoint because state and federal laws make it difficult to find information on physicians, but this much is clear: The database is one of the only publicly available avenues run by the government that lets consumers research physicians, and the errors are rampant.

Sometimes, the incorrect license numbers are off by a single digit, suggesting that they might simply be typos. But in other instances, the numbers are entirely different – and on occasion they seem to distance certain doctors from sketchy pasts.

Several data experts – including former CMS employees – didn't know about the errors until alerted to them by The Enquirer. Some expressed concern that the errors could be exploited to intentionally mislead patients.

Shouldn't the info be helpful?

Marsidi uncovered the mistakes through his company EZDoctor, a service he likens to Carfax, which provides vehicle history reports to consumers.

Marsidi said he first learned of the rampant errors in the federal database after a customer reported he was given incorrect information about a doctor.

"We went to the listing and tried to figure out what happened," Marsidi told The Enquirer. "We had been trusting the NPIs with some degree of accuracy, but we noticed that a lot of them weren't linking to the correct physicians' ID numbers."

Marsidi presented his findings to The Enquirer, which the newspaper corroborated. Marsidi said he alerted the CMS to the mismatches but was met with indifference: Officials advised him to contact the individual physicians about mistakes in their listings. Considering that there are 35,000 such mistakes in New York alone, Marsidi said that wasn't a realistic solution.

In a series of written responses to Enquirer questions, CMS officials said they weren't aware of any instances in which doctors provided bogus state license numbers with the intent of misleading consumers. They also said that the agency last year began performing license validation on applications for new, changed or reactivated National Provider Identifiers, but they didn't say whether they would address the tens of thousands of mismatches currently lingering.

Why isn't there more data?

Any patient who's done research on his or her doctor knows how difficult it can be. As The Enquirer reported in March, patients are blocked from accessing enough information to make educated choices about which doctors to visit. The Medical Board of Ohio keeps confidential any complaints made to it until disciplinary action is proposed.

Ohio isn't alone: The Health Care Incentives Improvement Institute – a nonprofit organization focused on improving health care quality – in December released a report that gave 44 states and the District of Columbia failing grades on a report card that rated how well they provide the public with information about doctors. Ohio, Kentucky and Indiana all received failing grades.

"Consumers are flying blind when it comes to selecting hospitals and physicians," the institute's report stated, "and the overall quality and affordability of American health care won't be improved until we find a way to solve this problem."

Because of the dearth in data, privately run online reviewing sites have proliferated, including sites such as Healthgrades.com, Vitals.com, RateMDs.com and ZocDoc.com. These sites typically merge online reviews, medical board actions and – when available – medical malpractice suits, while presenting physicians' educational backgrounds and areas of expertise.

Evan Marks, Healthgrades' chief strategy officer, acknowledged that his company relies in part on National Provider Identifier. He said it's among the many "data feeds" that help provide information about hundreds of thousands of physicians nationwide.

Marks said sites like his exist because consumers are hungry for more information about health care professionals. Physicians' lobbying groups have long histories of thwarting efforts to make doctor information more accessible.

Take, for example, malpractice lawsuits: "They absolutely would not want people wanting to see malpractice information," Marks told The Enquirer. "The majority of states don't actually report malpractice information (because of) lobbying efforts."

Here's the reasoning: Lawsuits are considered a controversial measure of a physician's effectiveness because they can be filed by anyone upset by a death or complication, even when the doctor could do nothing to avoid it. Lobbying groups say it's unfair to let consumers paint a physician as ineffective by using lawsuits that might have been filed by people using them as scapegoats.

Evans acknowledged that it's an imperfect tool, but he said that consumers are smart enough to realize that not all lawsuits are valid. He said it's unfair that consumers are regularly told to be their own health care advocates only to be handcuffed by incomplete information.

Why bother with ID numbers?

So what's the point of the National Provider Identifiers?

Simply put, they were created to give physicians a standard provider number for health insurance claims, said Karen Milgate, the CMS' former deputy director of the Center for Strategic Planning.

"HIPAA tried to make it all more standardized," Milgate said. "Individual providers are supposed to have them."

Marsidi compares a physician's NPI to a vehicle's VIN – vehicle identification number. In both cases, the numbers are unique and never recycled. Extending his Carfax analogy, Marsidi likened state license numbers to license plates.

Current CMS officials responded to a series of Enquirer questions via email, in which they said that physicians are required to provide accurate information on their applications for National Provider Identifiers. They're also supposed to keep that information updated if anything changes.

Though state license numbers don't often change, physicians have the ability to freely change the number they have listed in the federal database, just as easily as they might change their office address or phone number. CMS officials said doctors might do that if they relocate to another state, if they have a change in specialty that leads to them being issued a new license, or if a temporary license or permit is issued that later is replaced by a permanent license.

These aren't the types of discrepancies Marsidi uncovered.

EZDoctor took care to "normalize" their data to weed out instances of easily explained flubs, such as a doctor changing her name because she got married. New York – which is an outlier with its 35,000 mistakes – has some entries with clearly fabricated state license numbers that contain non-numeric entries, such as "X" or "#," in lieu of digits, Marsidi said. In Florida, one doctor's license number is used about 30 separate times for different physicians in the federal database.

The Enquirer analyzed a list of Ohio physicians whose NPI listings included incorrect state license numbers. The list included 187 physicians, about 20 of whom had connections to the Cincinnati region.

Here's a typical scenario: Cincinnati gynecologist Chandra Gravely is well reviewed on Vitals.com and Healthgrades.com. She has the wrong state license number listed in the federal database, directing searchers instead to another Ohio doctor with an inactive license and a specialty in internal medicine.

Gravely has been sued six times in Hamilton County over the past 16 years, with each lawsuit either being dismissed or ending with a jury siding with the gynecologist.

The Enquirer called Gravely for comment, but she declined through Kelly Beloff, practice manager at Crescent Women's Medical Clinic. Beloff said the error appeared to be a typo and said they'd correct the mistake. "Dr. Gravely has no comment on the other instances," she said.

Another physician, Jennifer Ann Lentini, said she had "no idea" why her listing was incorrect. "Maybe take it up with the people in charge," she said in an email.

The Enquirer tried, but each agency contacted passed the buck. A spokeswoman for the Ohio medical board said the state agency has nothing to do with the federal database and referred questions to CMS. CMS said that license information is self-reported by the physicians, who are required to provide accurate information.

Asked if agency officials were concerned with the instances of mistakes in the NPI database, officials replied: "Any potential for fraud, waste or abuse takes a severe toll on the Medicare Trust Funds and is of the utmost concern to CMS. CMS expects physicians and other practitioners to provide correct information when applying for NPIs and to keep their information current."

Why so widespread?

After uncovering the errors, Marsidi's EZDoctor changed its algorithms to correct the erroneous state licenses pulled from the federal database.

To Marsidi, the biggest mystery is how the mistakes became so widespread in the first place. He said he can't help but wonder: Are any of the mistakes the result of an unscrupulous doctor who changed his or her license number intentionally?

He points to Florida, where about 100 doctors have mismatched license numbers in the database that can't be explained by hyphenated names or misspellings. Marsidi's staff analyzed those 100 and found that 30 percent belonged to doctors who had criminal convictions or board actions, but whose incorrect license number was connected to someone who had "clean" backgrounds.

One had lost his license in another state, but was licensed anew in Florida.

It all might be innocent, Marsidi said, but he's frustrated that he can't know for sure.

"There could be real reasons this happens that maybe we just haven't thought of," he said, "but I can't figure out how it got past the system."

Acronym Breakdown

The Enquirer typically tries to steer clear of using confusing government-agency titles and acronyms, but when reporting on federal health care issues, it's difficult to avoid. Here's a glossary of relevant terms:

CMS: Centers for Medicare & Medicaid Services. The agency is responsible for administering several key federal health care programs and falls within the U.S. Department of Health & Human Services.

NPI: National Provider Identifier. This is a unique 10-digit identification number assigned to physicians by CMS. It's searchable through a database at www.npidb.org.

HIPAA: Health Insurance Portability and Accountability Act. This law, enacted in 1996, is meant to make it easier for people to keep health insurance, to protect the confidentiality and security of health-care information that's gathered, and to help the health-care industry control administrative costs. More information is available at http://www.hhs.gov/ocr/privacy/.