The world of medicine is changing rapidly and as a new physician entering the marketplace you should become keenly aware of and familiar with two nationwide databases that have been created over the last several years.
- The National Practitioner Data Bank (NPDB), and
- The Healthcare Integrity and Protection Data Bank (HIPDB)
Both of these databases were compiled as part of an integrated initiative to respond to congressional legislation.
It is critically important for all healthcare professionals to understand how these databases are created and maintained, who has access to the data and what they can use it for, and – perhaps most importantly – your rights as a practitioner regarding how information about you within these databanks can be used.
In this CareerPhysician Tool we will –
- offer a brief overview of these national databases
- provide suggested guidance for how to use the databases
- include links to the online databases
The source for much of this information is the National Practitioner Databank web site at http://www.npdb-hipdb.com/index.html
National Practitioner Data Bank (NPDB)
The NPDB was established by Congress as part of the Health Care Quality Improvement Act of 1986. By federal law, information on all medical malpractice payments and on certain adverse actions must be reported to the NPDB.
This legislation and the subsequent HIPAA Act (1996) were enacted because Congress felt the increasing occurrence of medical malpractice litigation and the need to improve the quality of medical care had become nationwide problems that warranted greater efforts than any individual state could reasonably undertake.
Ultimately, the intent of the legislation is to improve the quality of health care delivered to patients by encouraging state licensing boards, hospitals and other health care entities, and professional societies to identify and discipline those who engage in unprofessional behavior. Used correctly, the goal is to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history.
Potential sanctions for violations are strong, including the suspension and revocation of licenses, clinical privileges, professional society memberships, and exclusions from participating in Medicare and Medicaid.
Healthcare Integrity and Protection Data Bank (HIPDB)
The HIPAA legislation also led to the creation of the HIPDB, with the goal to combat fraud and abuse in health insurance and health care delivery.
Health care fraud and its cost to the system is a serious threat to the quality of health care and patient safety. Estimates of annual losses due to health care fraud range from 3 to 10 percent of all health care expenditures – between $30 billion and $100 billion based on estimated 1997 expenditures of over $1 trillion.
The HIPDB uses a flagging system to alert users that a comprehensive review of a practitioner’s, provider’s, or supplier’s past actions may be prudent. It is meant to augment, not replace, traditional forms of review and investigation, serving as an important supplement to a careful review of a practitioner’s, provider’s or supplier’s past actions.
National Practitioner Databases and You
Access to information in the NPDB and HIPDB is available only to listed “Authorized Agents” – entities that meet specific eligibility requirements defined in the provisions of P.L. 99-660 and the NPDB regulations. In order to access information, entities must first register with the databank.
The types of entities that can register and access the databank include —
- medical examining boards
- state licensing boards
- professional societies
- other healthcare service providers
- federal agencies
You, as an individual healthcare provider have access to your own information in the databanks – we’ll discuss this further below. Full access to information is generally not available to the general public. However, information in a form that does not identify any particular entity or practitioner is publically available.
Information reported to the databanks is considered confidential and cannot be disclosed except as specified in the NPDB and HIPDB regulations.
The Privacy Act of 1974, protects the contents of federal systems of records such as those contained in the NPDB and HIPDB from disclosure, unless the disclosure is for a routine use of the system of records as published annually in the Federal Register.
Authorized users of NPDB and HIPDB information are not allowed to disclosure that information to the general public.
Misuse of Data
The Office of Inspector General (OIG) and Health and Human Services (HHS), have the authority to impose civil money penalties on those who violate the confidentiality provisions of the legislation by misusing information stored in the NPDB or HIPDB data.
Persons or entities that receive information either directly or indirectly are subject to the confidentiality provisions and the imposition of a civil money penalty of up to $11,000 for each offense if they violate those provisions.
For more information on the NPDB, see the NPDB Tenth Anniversary Timeline or the Fact Sheet on the NPDB
The National Practitioner Databank contains information about doctors and other health care practitioners who have had medical malpractice suits filed or adverse action taken against them. Even though individual names are not included, news organizations and other parties have been able to overlay these databases with other public data, e.g. court records, to determine the identity of individual practitioners.
This database includes information on malpractice payment and adverse licensure, clinical privileges, professional society membership and adverse actions concerning physicians, dentists and other licensed health care professionals.
The public version of the databank, in an effort to shield information that would identify the individual physician, removes information indicating year of medical school graduation or offers date ranges only in decades.
The NPDB also collects and disseminates information about professional liability payments made on behalf of a physician. The terms of engagement include voluntary surrender or restriction of privileges either while under investigation or in lieu of an investigation.
This settlement information by its nature is disseminated widely. So these settlement decisions must be carefully evaluated, because even the settlement of a nuisance case with no real merit could have an impact on the physician’s record with the NPDB.
This is important to you because this information can affect licensure, medical staff privileges, contractual arrangements with managed-care organizations, and future insurability by traditional carriers
As a practicing physician you should remember that these mandated initiatives serve the better good for both the patient and for the ethical, competent and responsible caregiver.
But it’s also important to remember that computer and information systems are not without potential flaw and the data they contain will not always be 100% accurate or infallible.
Nothing is more chilling than not knowing what sort of information about you – personally or professionally – is being stored, updated and distributed within publicly accessible databanks.
You should make it a habit to routinely review and assess any relevant records being maintained on either of these two national databases associated with your name.
The best way to manage and reduce any potential downside to your career that might result from the negative influence of the NPDB or the HIPDB is to take control over the information stored there.
The first step is to perform a self-query of the combined databanks to see if there is information about you stored in the database. To run a self-query, follow this link https://icd.npdb-hipdb.com:663/servlet/SelfQueryFrameServlet and compete the online form. You will need a credit card and will be asked to pay $16 per query, $8 each for NPDB and HIPDB.
Once your self-query request is processed, the databanks will send a response to the e-mail you provide. The self-query response will consist of either a notification that no information exists in the databanks, or a copy of all information concerning you that has been submitted by eligible reporting entities.
When initiating a self-query, be sure to select a Report Password that will allow you to access the Report Response Service. The service allows you to add, modify, or remove a Subject Statement, initiate or withdraw a dispute or request for Secretarial Review, or modify your address as maintained by the databanks.
If you are ever the subject of a report, you will be assigned a unique, confidential password to access the Report Response Service.
For more information about the databanks and how to query, dispute and control information stored there about you, access the helpful documents linked below.
What Else You Can Do
It’s important for each 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. You should routinely request and carefully check any reports as they come to you.
If you disagree with the information contained within a report, you may dispute it. 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.
Your statement must be limited to 2,000 characters, including spaces and punctuation. It will be released with the report to all future queriers of the NPDB, and notification of the statement will 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.
A number of healthcare industry organizations have raised various points regarding the potential legal exposure that could occur from the misuse or misapplication, or widespread dissemination of the information stored within NPDB/HIPDB databases.
- The accuracy of the NPDB information is questionable. Specifically, NPDB data relies on the accuracy of the reporting entity; the NPDB itself takes no responsibility for the accuracy of any reports made to it.
- The databank may contain information that creates an inaccurate portrayal of any particular physician if considered in isolation.
- Depending upon the specialty, anywhere from nearly half to four-fifths of all physicians report being sued at some point in their career. As a result, it is unclear how information on a particular physician can accurately assessed or used.
- There is no more complex or litigious field than modern health care, and the need for medical tort reform has been plain for some time. It is difficult to see how releasing copious amounts of information, which primarily reflect the wide-spread use of medical tort laws, will aid the public in choosing competent physicians.
Source: American Academy of Family Physicians http://www.aafp.org/x980.xml
We all know that the vast majority of healthcare practitioners are fully competent and committed to the highest standards of ethical behavior. However, practitioners involved in health care fraud and abuse can cost their organizations millions of dollars, in addition to injuring patients.
Both the NPDB and the HIPDB provide useful tools to identify and manage information on malpractice, fraud and abuse in the medical profession. However, the potential for an unwarranted negative impact on your career is something you need to keep in mind.
Take charge of your information. Conduct a self-query regularly, carefully review any reports that concern you, and know how to file disputes and supplementary statements.
About the Author:
Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.