Data bank merger: More reports likely

Officials say changes should be seamless

The National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB) announced a merger in April that became effective last month. According to Ernia P. Hughes, MBA, the acting director of the division of practitioner data banks at the Health Resources and Services Administration, the main reason for the unification is to save money and curtail duplication of services.

The new organization, known as the NPDB, can be found online at http://www.npdb.hrsa.gov, where fact sheets, newsletter articles and other resources are available for users.

The HIPDB, created in 1996 as part of the HIPAA law, held information on:

• civil judgments against health care providers, suppliers, or practitioners in federal or state court related to the delivery of a health care item or service;

• federal or state criminal convictions against health care providers, suppliers, or practitioners related to the delivery of a health care item or service;

• actions by federal or state agencies responsible for the licensing and certification of health care providers, suppliers, or practitioners;

• exclusions of health care providers, suppliers, or practitioners from participation in federal or state health care programs;

• any other adjudicated actions or decisions against health care providers, suppliers, or practitioners that the secretary establishes by regulations.

The NPDB included reports of adverse licensure, and hospital privilege and professional society actions against physicians and dentists related to quality of care. In addition, the NPDB tracked malpractice payments made for all health care practitioners. It was created in 1990.

The new merged organization will contain all the information from the two independent units in one organization.

Hughes says the Affordable Care Act’s passage in 2010 set the stage for the merger, calling for the elimination of duplicative data reporting requirements between the two databanks.

The public doesn’t have access to the data — that’s part of the laws that created the data banks and remains in effect. Mostly, Hughes says the merger was technical and doesn’t impact users’ “legal requirements to report to and query the NPBD.”

Users shouldn’t notice much change and little difference in the way they use the system. What they might note is an increase in reports, Hughes says. “Hospitals have always had access to adverse licensure actions,” she notes. “However, prior to the merger, adverse licensure actions taken against practitioners and entities were in one data bank and those same actions against providers and suppliers were in another.”

Now, because there is just a single entity, reports on health care providers and suppliers are captured under one umbrella, so licensure and certification actions taken against providers and suppliers can be returned on a search when a hospital queries the NPDB.

In addition, she continues, hospitals now have access to reports on federal health care-related criminal convictions, federal health care-related civil judgments, exclusions from participation in federal health care programs, or other adjudicated actions that are reported by federal agencies and health plans. State actions, federal actions for suppliers and providers, plus information on privileges and malpractice claims will all be in one place.

Costs of operation will continue to be funded by user fees, and Hughes says there may be a savings here, too, because users will not have to query two different organizations. Only one query fee will provide access to all the information to which users are entitled.

Those fees are not going up, either, she says. The annual subscription fee for Continuous Query will continue to be $3.25 per practitioner enrolled. Traditional Query, also known as a One-Time Query, will still cost $4.75 each. Fees for Veterans Affairs hospitals have a different fee structure and should contact the customer service center at (800) 767-6732.

While fees are not set to change, Hughes says that any plans to do so will have to be published in the Federal Register first, and users will have to be notified.

If you have any specific merger questions, you can email the data bank directly NPDBPolicy@hrsa.gov. For technical help or general questions, email help@npdb-hipdb.hrsa.gov.