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Hospitals are running a considerable risk if they rely too heavily on the National Practitioner Data Bank (NPDB) as a source of information throughout their credentialing process.
"The data bank is a useful tool," asserts Carol Ostermann, CMSC, CTCS, manager of medical staff services at St Mary’s Medical Center in Long Beach, CA. "But it is certainly not the answer to all the questions that we have to answer when we are credentialing."
A report recently released by the General Accounting Office (GAO), which found the data bank riddled with problems, only underlines that point. The government watchdog agency says problems of underreporting to the NPDB make it a questionable source of information regarding disciplinary actions taken against health care practitioners by hospitals and other health care providers.
Worse yet, the Department of Health and Human Services (HHS) has no plan to fix the problems, even though the HHS Office of Inspector General has long considered that the weakest link in the entire process, according to the GAO.
The problem facing hospitals is that the NPDB is the only national repository of this information nationwide that is accessible to hospitals. "Unfortunately, it is the only mechanism that exists nationally that has this kind of data," says health care attorney Mark Kadzielski of the Los Angeles-based Akin Gump. He notes that the Healthcare Integrity and Protection Data Bank holds five times the information included in the NPDB, but hospitals remain locked out of that resource. "The problem in credentialing is that just because you don’t get any information from the data bank it does not automatically mean that the doctor is a qualified professional," he says. "There may be many reasons that information is not in there."
That creates a challenge for hospital staff who are responsible for credentialing. "Quality management people look at themselves as patient advocates," says Marie Pears, RHIA, CPHQ, quality coordinator at Meadville (PA) Medical Center. "This first place you start is with a qualified practitioner, which makes this information very important."
But that is easier said than done, she adds. "We can access information on licensure actions for most of the states, but you don’t always know which states a practitioner may be licensed in," she explains. For example, a practitioner may have been licensed in a state where an event occurred that affected his or her license. "However, if it was not reported to the practitioner database, you miss that piece," she explains.
While hospitals must rely on the information reported to the NPDB on a national level, it is not the only resource available. "You can never be too thorough in credentialing a practitioner by looking in various places," adds Pears. "We are always trying to double-check information and find areas where we can look for additional information."
According to Vi Griffin, director of quality management at Craig Hospital in Denver, while it is important to have this information centralized in a timely fashion, the safest route for hospitals is to make the data bank only one component of a much broader credentialing process.
Lynn Buchanan, CHSC, CPCS, president of Buchanan & Consultants in Morrison, CO, takes a similar view. "I think hospitals are only semireliant on the data bank," she says. "We use the data bank as a backup or in addition to licensing boards, medical associations, and malpractice carriers."
According to Buchanan, hospitals may be able to get additional information from the licensing board, the hospital, or the malpractice carrier that might not have been reportable to the data bank because it did not meet the data bank’s criteria. In some cases, hospitals are not as diligent in reporting information as they should be, she adds. In the malpractice arena, Buchanan says one reason for going beyond the NPDB is that the data bank only includes information about malpractice cases that have been settled, not those still pending.
According to Ostermann, the only method that is entirely reliable is talking to the institution where the event occurred. "The best information in this area is directly from the source," she argues. "I still think the human aspect is the most important database that we have."
Buchanan also points out that not all the problems associated with the data bank are internal. "Everybody is always looking for loopholes to keep from reporting to the data bank, which is unfortunate. The data bank can only be as good as the information that is sent to it."
According to the GAO, HHS’s efforts to quantify or minimize underreporting have been largely unsuccessful. For example, GAO says that HHS has focused on the underreporting of malpractice payments even though government-sponsored studies conclude that underreporting of clinical privilege restrictions by hospitals and other health care providers is a far more pressing issue.
The GAO also points out that HHS has failed to implement a 13-year-old law that expanded NPDB to include information on nurses and other health care practitioners. "As a result, disciplinary actions taken against nurses and other practitioners are not reported to the NPDB, despite these individuals’ increasing importance in the delivery of health care," says the agency.
HHS concurs with the GAO that it must improve compliance with reporting requirements. But it balks at the agency’s recommendation to develop procedures to ensure the accuracy and completeness of NPDB information. HHS is also resisting the GAO’s recommendation that it should revise its notification to users regarding limitations in the data.
Unfortunately, Congress will not be able to rectify these problems until next year at the earliest. Earlier this year, legislation was introduced that would open the NPDB to public scrutiny via the Internet and give the public access to disciplinary information about adverse actions in its current form along with additional information to compare physicians within a particular specialty or a given state. But that legislation died.
The Chicago-based American Medical Association says the solution lies in going beyond the NPDB. It says individual states have made significant progress in their ability to collect and disseminate the same information. The association points out that information about physician credentials and disciplinary action already is available through state-based systems.