Will the Division of Practitioner Data Bank’s Recent Report Lead to National Practitioner Data Bank Changes?

The NPDB, described on its website as “a confidential information clearinghouse created by Congress with the primary goals of improving health care quality, protecting the public, and reducing health care fraud and abuse,” is meant as “an alert or flagging system intended to facilitate a comprehensive review of the professional credentials of health care practitioners, health care entities, providers, and suppliers…” Accordingly, health care organizations interacting with the NPDB should keep in mind that it is not a licensing agency and does not conduct investigations, but rather, its mission is to collect and, upon appropriate request, disseminate reports about certain adverse privileges actions, restrictions of practice, professional liability judgments and settlements, and other similar developments in a provider’s professional life.

The NPDB is monitored by the Health Resources and Services Administration, Bureau of Health Workforce – Division of Practitioner Data Bank (DPDB). In 2012, the DPDB initiated discussion groups with various stakeholders to analyze hospitals’ NPDB querying and reporting. On November 24, 2014, the DPDB sent discussion group participants a document titled, Monitoring National Practitioner Data Bank Hospital Reporting of Adverse Actions Taken Against Clinical Privileges: Summary of Discussions. To read the document, click here.

Although it does not make or propose (in any formal sense) changes to the NPDB, we found several areas of significance in the Summary of Discussions. First, it signifies that the DPDB is interested in how the NPDB reporting scheme is viewed by the world of potential reporters. Second, the Summary of Discussions provides some fascinating perspectives on issues relating to peer review and peer review reporting, especially on how changes to the health care delivery system over the past three decades have affected both. The submitted comments reveal continuing uncertainly among hospitals and certain other provider organizations about how the reporting requirements apply to organization-physician relationships in today’s world.

In our experience, most of these understandable uncertainties can be addressed by recalling the considerations and values that impelled the NPDB’s creation. Specifically, Congress created the NPDB to gather reports about significant restrictions of physicians’ practices that were predicated on concerns about quality of care and professional conduct. Most actions will have at least the appearance of validity, given that at most hospitals, adverse actions result from formal investigations and peer review processes conducted by health care providers bearing credentialing and quality improvement responsibilities.

The Summary of Discussions raises (to our minds) a significant question: What is the final goal of the DPDB’s study? In the Summary of Discussions, the DPDB states it formed the discussion groups and held meetings with a large teaching health system in order to gain perspectives regarding hospitals’ NPDB use, as well as to “gain a deeper understanding of hospital policies, procedures, and practices in order to develop a meaningful approach to monitor hospital use of the Data Bank.” Presumably, that deeper understanding is meant to be put to use. Ultimately, will DPDB use the information it gathered to develop ways to better guide hospital compliance within the current system, or to propose more fundamental changes to the NPDB? The DPDB also notes that it will use suggestions proposed by the stakeholders to “inform the compliance plan for hospitals.” What kind of “compliance plan” is intended remains unclear — however, many of the participants’ proposed suggestions appear outside of the NPDB’s current scope.

More information on the NPDB generally, and on compliance with its reporting requirements specifically, is available on the NPDB website.