Who's afraid of the NPDB?

Key Points

When Katherine Martin, an FP in San Diego, asked a friend to cover for her while she was on bed rest during a difficult pregnancy, she got more than she bargained for. The covering doctor neglected to check the chart of a patient who failed to follow through on Martin's recommendation that he be tested for a potentially life-threatening condition. A bad outcome-and a lawsuit-ensued.

In time, the case was settled, but its impact on Martin didn't end there. Because her name now appeared in the National Practitioner Data Bank, the local hospital denied her privileges.

Martin, a self-described "Data Bank survivor," relocated to a rural area and established a successful solo practice. Nonetheless, she'll remain on the NPDB list indefinitely, along with an estimated 20 percent of the nation's physicians.

The stated intent of the Data Bank is to improve the quality of healthcare by preventing incompetent practitioners from evading disclosure of malpractice or misconduct by moving from state to state. In the 18 years since its 1990 inception, however, the NPDB has exceeded the bounds of its original purpose. If the proposed amendment to the NPDB, known as Section 1921, is finalized by HHS as expected, the Data Bank will have an even broader reach. (See the box below to learn more about Section 1921.)

Created as a result of federal legislation, this government-administered electronic repository houses reports on medical malpractice payments, Medicare/Medicaid exclusions, licensure sanctions that are competence- and conduct-related, and adverse actions associated with clinical privilege or professional society membership. As of June 30, 2007, there were more than 300,000 reports on physicians in the NPDB and the Healthcare Integrity and Protection Data Bank (HIPDB)-a sister repository for reports on fraud and abuse. All told, there are listings for almost 170,000 individual physicians. The vast majority of them, it's safe to say, practice well within the standard of care.

So what are the criteria for a Data Bank listing?

• Any company or organization that pays an award or settlement resulting from a malpractice claim on a physician's behalf is required to report it to the NPDB, no matter how insignificant or meritless.

• State medical boards must report any restriction of a physician's license related to professional conduct or competence, including revocation, suspension, censure, reprimand, probation, and surrender.

• Hospitals and other healthcare entities must report professional review actions that adversely affect a physician's clinical privileges for more than 30 days; voluntary surrender or restriction of clinical privileges by a doctor under investigation for professional incompetence or misconduct must also be reported.

• Professional societies must report any adverse membership review action based on professional misconduct or incompetence.

The report must include a narrative detailing the incident involved.

In turn, hospitals must query the NPDB whenever a physician applies for privileges or medical staff membership, and biennially for all physician employees. Other entities, such as state licensing boards, professional societies, and managed care plans, may query the Data Bank-and most routinely do. (To view a sample of the report an organization would receive upon querying the Bank, go to http://www.npdb-hipdb.hrsa.gov/itp.html and look under Item 5.)

None of the information in the NPDB is available to the general public. Nor is it available to medical malpractice insurers or defense attorneys.