AHCJ disappointed with ACGME’s response on transparency

Charles Ornstein

About Charles Ornstein

Charles Ornstein is a senior reporter with ProPublica in New York. The Pulitzer Prize-winning writer is a member and past president of the Association of Health Care Journalists' board of directors and a member of its Right to Know Committee.

ACGME-Response8-12-2014-1The Accreditation Council for Graduate Medical Education has rejected a request from AHCJ to publicly release additional information about the successes and failures of physician training programs nationwide.

Earlier this month, AHCJ called upon ACGME to release details about residency programs with less than full accreditation, as well as the rates at which graduates of residency programs pass their board certification examinations. ACGME posts decisions on favorable or less-than-favorable accreditation status but not the reasons for them.

Replying to AHCJ’s Aug. 5 letter, ACGME executive director Thomas J. Nasca, M.D., wrote that the organization would not provide the requested information, citing the confidentiality of ACGME’s review and decision process.

AHCJ president Karl Stark said he was disappointed by ACGME’s response.

Karl Stark

Karl Stark

“The whole of medicine is growing more transparent,” Stark said. “Doctors and hospitals are getting rated. Even Medicare is getting in the act, releasing data on spending and quality and penalizing hospitals for poor hospital readmission rates and low patient satisfaction. It seems the ACGME’s sense of secrecy is behind the times.”

Stark noted that Medicare publicly releases details on hospital deficiencies in electronic format, which AHCJ has made searchable at www.hospitalinspections.org.

Defending ACGME’s current system of limited public disclosure, Nasca wrote:

“The accreditation status of each accredited program is posted on the ACGME public website. However, ACGME maintains the citations as confidential for reasons that are intrinsic to the ACGME accreditation process. Standards can be judged not to be fulfilled by the program, but the magnitude of infraction of the same standard may have different significance in various settings. Merely counting of deficiencies is not the mechanism used to assess overall substantial compliance with standards.”

Sharing information about problems, Nasca added, “would have a chilling effect on ACGME’s ability to receive and provide full and frank information and evaluations.”

With regard to pass rates on board certification examinations, Nasca suggested that AHCJ request this information directly from individual medical specialty certification boards. “While the ACGME utilizes this information in its accreditation decisions as a component of assessment of quality of educational outcomes, it is not ACGME information. ACGME is not free to share such information,” he wrote.

AHCJ’s call for greater transparency in graduate medical education dovetails with the position of the Institute of Medicine, which last month decried the “striking absence of transparency and accountability” in the graduate medical education system (GME) system.

“The most fundamental questions about GME financing and program outcomes cannot be answered,” the Institute of Medicine committee wrote in its report. “These include, for example, questions regarding the bottom-line financial impact of residency training programs on teaching institutions, how GME public funds are used for educational purposes, the extent to which residents are trained in community-based settings, the specialties and demographic characteristics of funded trainees, the practice locations of recent trainees, whether recent trainees accept Medicare and Medicaid patients once they enter practice, and the quality of care delivered by these physicians.”

Reporters across the country have written about training programs with problems, but their stories have been unable to provide basic details about the problems at those facilities. These include stories in the St. Louis Post Dispatch and the State Journal-Register in Illinois.

AHCJ, particularly through its Right to Know Committee, will continue to push for transparency in graduate medical education, Stark said.

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