National Practitioner Data Bank
The National Practitioner Data Bank (NPDB) is an electronic repository of all payments made on behalf of physicians in connection with medical liability settlements or judgments as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other health care practitioners. The NPDB was established by Congress as part of the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101, et seq.). By federal law, information on all medical liability payments and on certain adverse actions must be reported to the NPDB. In turn, the NPDB is required to make this information available to hospitals, state licensure boards, some professional societies, and other health care entities under certain circumstances. The information is considered confidential and is released only to the eligible entities or to physicians and other health care practitioners who wish to conduct a self-query.
Section 1921 of the Social Security Act authorized the NPDB to collect additional information concerning negative findings and sanctions imposed by state licensing authorities, peer review organizations, and private accreditation organizations, against health care practitioners and entities. Read the AMA's 2006 comments on the regulations to expand the scope of the NPDB. In January 2010, the Department of Health and Human Services (HHS) issued a final rule on the Section 1921 expansions that became effective on March 1, 2010. Learn more about Section 1921.
NPDB reporting requirements
The NPDB collects and disseminates certain information, including:
- Professional liability payments made on behalf of a physician or other health care practitioners.
- Adverse action reports based on a physician or other health care practitioner’s professional competence or conduct that adversely affects privileges for more than 30 days. These actions include reducing, restricting, suspending, revoking, or denying privileges, and also include an entity's decision not to renew a physician's or other health care professional’s privileges if the decision was based on competence or professional misconduct. It also includes voluntary surrender of license or restriction of privileges either while under investigation or in lieu of an investigation. Voluntary surrenders relating to retirement, nonpayment of licensure renewal fees, and change to inactive status, if there is not an investigation in progress, are not reportable.
- Disciplinary actions related to competence or professional misconduct taken against a physician's license, including revocation, suspension, censure, reprimand, probation, and licensure surrender.
- Professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the professional society.
- Medicare and Medicaid exclusion reports containing sanctions against a practitioner from the Medicare program or the Medicaid program due to fraud and abuse.
A complete list of reportable information is maintained in the NPDB.
Section 1921 expands state reporting of licensure actions
Section 1921 requires each State to adopt a system of reporting to the Secretary of HHS certain adverse licensure actions taken against health care practitioners and health care entities by any authority in the State responsible for the licensing of such practitioners and entities. Section 1921 also requires each State to report any negative action or finding taken by a State licensing authority, certain final actions taken by a private accreditation entity (e.g., Joint Commission, National Committee for Quality Assurance (NCQA)) against a health care practitioner or entity, or recommendations to sanction taken by Peer Review Organizations against health care practitioners. For purposes of reporting under Section 1921, the term "peer review organization" only includes stand-alone organizations and does not include the internal peer review committees of hospitals, professional societies, or other health care entities. Peer review organizations and private accreditation entities are required to have a due process mechanism in place for health care practitioners, physicians, and entities. Section 1921 data is not available to the general public. Learn more about available data and authorized queriers under Section 1921.
Professional repercussions of a NPDB report
Even though the NPDB collects different types of information, a majority of the data collected consists of medical liability claims data against physicians.The AMA believes that medical liability claims data is a poor indicator of quality. Nevertheless, the NPDB is required to make this information available to hospitals, state licensure boards, some professional societies, and other health-care entities under certain circumstances. Despite the lack of a connection between medical liability claims data and quality, the data is intended to serve as a flagging or alert mechanism to put parties on notice that the physician may have competence or professional misconduct problems. Demands are increasing for this information to be made available to the public. Similar information may be available upon written request through the state licensing boards. Some licensing boards are even releasing this or similar data through their web sites.
How to ensure that NPDB reports are accurate
Due to widespread dissemination of settlement information, it is imperative that settlement decisions be carefully evaluated-as even the settlement of a nuisance case with no real merit may have an impact on the physician's record with the NPDB. This record can affect licensure, medical staff privileges, contractual arrangements with health plans, and future insurability by traditional carriers. It is also important for the physician to ensure that the information contained in the NPDB is accurate. Reports are routinely mailed to physicians when they are submitted to the NPDB. Check any reports as they come to you and also consider requesting a copy of the report for review.
If you disagree with the information contained within a report, you may dispute it within 60 days from the date the Secretary of HHS mails the report to you. Alternatively, if the information is technically accurate but misleading, you may wish to append your own statement relative to the events to the actual report. The statement is limited to 2,000 characters, including spaces and punctuation. The statement would be released with the report to all future queries of the NPDB, and notification of the statement would be sent to all queriers who previously received the report. The statements are entered into the computer system exactly as submitted to the NPDB and cannot be changed. So, be sure to stay within the space limitations. You may wish to consult an attorney for help in drafting the short piece to get the maximum effect of the limited opportunity to tell your side of the story.
For information about filing a statement or other information relative to the NPDB, visit the National Practitioner Data Bank or call the NPDB Help Line at (800) 767-6732 for recordings on common NPDB topics and developments seven days a week, 24 hours a day. To speak with a person live, call between the hours of 8:30 a.m. to 6:00 p.m. (5:30 p.m. on Fridays) Eastern Time.