The National Practitioner Data Bank (NPDB) is the entity established by the federal government on September 1, 1990, to ensure that unethical or incompetent physicians/providers do not compromise quality healthcare.
It was authorized by Congress in 1986 under the Health Care Quality Improvement Act and is primarily an alert or flagging system intended to facilitate a comprehensive review of a physician/provider's professional credentials. Hospitals and other healthcare entities (including professional societies and state licensing boards) should use the information contained in the NPBD in conjunction with information from other sources when granting clinical privileges or in employment, affiliation or licensure decisions.
Reporting to the Data Bank
The NPDB stores information that helps identify unprofessional conduct or problematic or incompetent performance by physicians, dentists and other licensed healthcare practitioners. The Data Bank collects and releases to eligible parties information such as medical malpractice payments, adverse licensure actions and adverse actions on clinical privileges and professional society memberships.
As a medical malpractice insurer, SCPIE must submit Medical Malpractice Payment Reports electronically to the Data Bank any time our company makes a payment on an insured’s behalf. All payments—whether one cent or $1 million—must be reported within 30 days of the payment or SCPIE can face civil money penalties. Reporting to the applicable state licensing board (such as the Medical Board of California) may also be required.
In addition, certain other activities require reporting to the Data Bank. For instance, if a physician is investigated regarding quality-of-care issues and his or her privileges are revoked, reduced or suspended for 30 days or more as a result, that must be reported. It may also require reporting to the applicable state licensing board.
Access to Information
Before the NPDB was established, a doctor or other healthcare professional who committed numerous acts of negligence in one part of the country could simply pull up stakes and set up practice elsewhere. The entity at the new location, lacking access to information about the practitioner's history, would unknowingly grant the negligent practitioner privileges. With the NPDB, however, all U.S.-based medical entities can request information on claims for any applying practitioner, regardless of where he or she practiced last.
The information contained within the Data Bank is controlled and highly confidential. The Data Bank is prohibited by law from disclosing information on a specific practitioner to a medical malpractice insurer, defense attorney, or member of the general public. Only authorized entities—e.g., hospitals, state licensing boards, managed care companies, other healthcare entities, professional societies and federal agencies—can make queries. Individual physicians, dentists and other healthcare practitioners can query to obtain information on themselves. (Healthcare practitioners may self-query at any time for a fee.)
Understandably, many physicians/providers are concerned about having claims information reported to the NPDB. The fact is, attorneys can access the Data Bank only under strictly limited and expressly controlled circumstances. For example, an attorney who has filed a malpractice action against a hospital can access information about a specific doctor, dentist or other healthcare practitioner named in the action only if the attorney proves that the hospital failed to query the Data Bank as required by law. Only then can the information be used, and solely for the malpractice action against the hospital for negligent credentialing.
Claim-free providers will find that the NPDB can accelerate the credentialing and reprivileging processes. As with any other human endeavor, however, the Data Bank is not immune to mistakes. Physicians/providers should periodically query the Data Bank to review their information and, if necessary, make corrections. Also, physicians should always verify that the hospital from which they receive privileges has queried the Data Bank as required by law.
To contact the NPDB, call 800/767-6732, or log on to www.npdb-hipdb.com.
