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Can Big Brother Keep a Secret? The National Practitioner Data Bank
Written by Ardena L. Flippin, MD, MBA   

Malpractice history and quality of health care are not synonymous.

In my most recent article I focused on physician profiling and described the emergence of how certain “expectations of efficiency” are being enforced.

In this article I describe the National Practitioner Data Bank (NPDB) – why it was created and its intent, what it does, how the information may be construed and new information about the data bank.

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The purpose of the NPDB 

There are two reported purposes of the NPDB: one intent was to prevent unprofessional or incompetent practitioners from moving from place to place in the hope of escaping discovery or disclosure of a past history of incompetent performance.

The other reason was U. S. Congress’ concern with increasing occurrences of medical malpractice litigation and improving the quality of medical care. The intent was to “improve quality” by encouraging the reporting of adverse information of practitioners by states, hospitals, healthcare entities and professional societies.

Physician profiles often include malpractice information, and as physician profiles are becoming accessible to the public via the Internet, a physician’s malpractice information may be misconstrued as the delivery of poor quality health. In fact, very little that is substantive can be discerned about the competence of a practitioner from the NPDB database.

The NPDB contains information on actions against physicians and dentists: adverse licensure actions, clinical privileges actions and professional society membership actions. It also contains actions against health care practitioners concerning paid medical malpractice judgments and settlements, exclusions from participation in Medicare/Medicaid programs, and registration actions taken by the U. S. Drug Enforcement Administration (DEA). The law specifies that NPDB make reported information available to hospitals, health care entities with formal peer review, professional societies with formal peer review, state licensing authorities, health care practitioners (self-query), researchers (statistics only), and in limited circumstances, plaintiffs’ attorneys. The NPDB is prohibited from disclosing specific information on practitioners to the general public.

Other Governmental Practitioner Databases

The Healthcare Integrity and Protection Data Bank (HIPDB), established under a section of HIPAA, intends to combat fraud and abuse in health insurance and health care delivery.

HHS is currently drafting regulations to implement Section 1921 of the Social Security Act. This act will add adverse licensure action reports on all licensed health care practitioners and entities into the National Practitioner Data Bank (NPDB). It also adds certain negative actions or findings taken by State licensing agencies, peer review organizations and private accrediting organizations (e.g., the Joint Commission of Healthcare Organizations). Section 1921 allows hospitals access to the adverse action reports on all health care practitioners.

In spring 2007 a prototype will be available of the Proactive Disclosure Service (PDS). The PDS will allow all eligible entities that choose to enroll their practitioners with the NPDB and /or HIPDB to be notified of new and updated reports that name any of their enrolled practitioners as subjects within one business day of the Data Banks’ receipt of the report.

An Imperfect System

But these large governmental databases don't necessarily provide an objective view of health care quality. Disciplinary actions are not based on objective criteria. Certain specialties are more likely than others to be the subject of litigation, some doctors work primarily with high-risk patients and settlements occur for a variety of reasons that do not necessarily reflect negatively on the professional competence or conduct of a physician. This means that settlements and actions are not a perfect reflection of provider competence. 

As more and more practitioners are incorporated into the reporting requirements, there is an increasing demand for this information to be made available to the public. But public disclosure would only muddy the waters, even the General Accounting Office has confirmed that reported information may be incomplete and inaccurate.

While public accountability is a noble goal, the methods need to be transparent and objective. With uneven application of health care standards and reasons for settlements other than health care quality, it is important that this information not be used to measure physician/practitioner competence.

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