Are the data bank’s big numbers useful?

The raw numbers reported from the National Practitioner Data Bank (NPDB) can seem impressive, but risk managers still question just how useful the data bank is as a resource for improving patient safety and reducing liability. In its most recent report, the NPDB reported that the data bank contained reports on 264,065 reportable actions, malpractice payments, and Medicare/Medicaid exclusions involving 164,320 practitioners. Those figures were current as of Dec. 31, 2000, the end of its 124th month of operations.

Of the 164,320 practitioners reported to the NPDB, 69.7% were physicians (including MD and DO residents and interns); 14.1% were dentists (including dental residents); 6.2% were nurses and nursing-related practitioners; and 10% were other health care practitioners. About two-thirds of physicians with reports (65.4%) had only one report in the NPDB, 85% had two or fewer reports, 97.4% had five or fewer, and 99.6% had 10 or fewer. Notably, few physicians had both Medical Malpractice Payment Reports and Reportable Action Reports. Only 6.2% had at least one report of both types.

Approximately 53% of all reports received during 2000 concerned malpractice payments, although cumulatively malpractice payments comprised 72.7% of all reports. The lower percentage of Malpractice Payment Reports for 2000 reflects a large number of Medicare/Medicaid Exclusion Reports received during 2000. These reports also were placed in the NPDB. During 2000, physicians were responsible for 80.3% of all Malpractice Payment Reports. Dentists were responsible for 12.2%, and all other health care practitioners were responsible for the remaining 7.5%. These figures are similar to the percentages from previous years.

Cumulatively, the median malpractice payment for physicians was $99,500 ($105,708 adjusting for inflation to standardize payments made in prior years to year 2000 dollars), and the mean malpractice payment for physicians was $202,301 (approximately $225,600 adjusting for inflation). Both the mean and the median payments for 2000 were higher than the cumulative figures. During 2000, as in previous years, obstetrics-related cases, which represented approximately 8.3% of all physician Malpractice Payment Reports, had the highest median and mean payment amounts ($225,000 and $417,181, respectively).

The median obstetrics-related payment for physicians was $25,000 more than 1999, and the mean was $55,329 more than in 1999. Incidents relating to equipment/product failures (0.19% of all reports) had the lowest mean and second-lowest median payments during 2000 ($73,821 and $45,000, respectively). For all medical malpractice payments made during 2000, the mean delay between an incident that led to a payment and the payment itself was 4.48 years. This is about three and a half days longer than in 1999. The 2000 mean physician payment delay varied markedly between the states, as in previous years, and ranged from 2.99 years in Minnesota to 6.28 years in New York.

Reportable actions (licensure, clinical privileges, professional society membership, and DEA actions) represent 18.1% of all reports received from Sept. 1, 1990, through Dec. 31, 2000, and 15.5% (5,703 of 36,763) of all reports received by the NPDB during 2000. The 5,703 reportable action reports received during 2000 are 9.9% more than the number of reportable actions submitted to the NPDB during 1999, reversing a decline of 2.9% from 1998 to 1999. The number of licensure action reports received increased 12% and the professional society membership action reports increased 66.7%, from 18 in 1999 to 30 in 2000. During 2000, licensure actions comprised 80.5% of all reportable actions and clinical privileges reports comprised 18.9% of the total.