The National Practitioner Data Bank (NPDB) is under fire again. This time the source is a congressional watchdog agency. Its recent report cites a flawed system hindered by incomplete, inaccurate, and untimely reports about physicians.
The AMA, a longstanding critic of the NPDB, said that the General Accounting Office (GAO) report released last November confirms its contention that the NPDB is ineffective and should be abolished.
The NPDB was mandated by Congress under the 1986 Health Care Quality Improvement Act with the intent of preventing incompetent physicians, dentists, and other health care practitioners from setting up practice in another state or health care organization, according to the GAO report.
The legislation mandated that state licensing boards must report the names of practitioners they have disciplined; insurers must report medical malpractice payments made on behalf of practitioners; hospitals and health care plans must report restrictions on clinical privileges lasting more than 30 days; and professional medical societies must report adverse membership actions, according to the GAO investigators.
HMOs are not required to file adverse actions taken against practitioners.
The law requires only hospitals to query the databank when a practitioner applies for clinical privileges and to do so every two years for practitioners already on staff. However, health care plans, state licensing boards, and professional societies can access the NPDB.
Although the GAO report doesn’t state whether the NPDB has succeeded in its goal of weeding out incompetent practitioners, it is clear about what improvements are needed to enhance its effectiveness. The GAO analyzed reports submitted to the NPDB during September 1999.
The GAO report criticizes the federal Health Resources and Services Administration (HRSA), which manages the NPDB, for its heavy reliance on medical malpractice payment data. Eighty percent of the NPDB reports come from malpractice insurers compared with 15 percent from state licensing boards and 5 percent from hospitals and health plans, according to the GAO investigators.
"Experts widely agree that disciplinary actions by state licensing boards and health care providers are better indicators of professional incompetence than malpractice payments," the investigators claim.
In addition, it takes an average of five years to resolve malpractice claims, giving practitioners ample time to move to another state or change health care plans or employers, the report states.
The GAO investigators agreed with HRSA’s claim that many health care providers and facilities do not report practitioners with restricted clinical privileges. HRSA estimates that 60 percent of the nation’s hospitals have never reported any practitioner to the NPDB.
The number of restricted-privilege reports received by the NPDB falls dramatically short of the number originally predicted. The AMA projected that the NPDB would receive up to 10,000 reports annually when it began operating in 1990. Instead, the databank receives an average of just 1,000 reports annually, according to GAO investigators.
Another flaw in the NPDB is that reports from state licensing boards and health care providers are often late, inaccurate, and submitted in duplicate, giving the impression that a practitioner has twice the number of disciplinary actions taken, the investigators found.
"Moreover, when mistakes were made, practitioners encountered problems getting the information corrected," the report states.
HRSA responded to the GAO findings by promising to correct the problems, but added that it does not have the authority to fine late reporters. HRSA also told the GAO that notifying practitioners when reports about them are filed along with its dispute-resolution processes are sufficient mechanisms to correct misinformation.
The GAO also found that many medical malpractice reports had incomplete narratives that fell short of HRSA’s guidelines. The narratives rarely described the events leading up to the malpractice claim, "which can help users identify potential weaknesses or problems in a practitioner’s past performance," the investigators stated.
The narratives also rarely mentioned whether a determination had been made showing that the standard of patient care was violated.
Even more disturbing is that patient and practitioner names were frequently mentioned in the narratives, violating NPDB reporting instructions and patient privacy, according to the investigators.
Given the AMA’s longstanding criticisms of the NPDB, it was not surprising that the physician organization applauded the GAO report.
Its release undoubtedly facilitated the passage of a recommendation by the AMA House of Delegates in December that the AMA work with state licensing boards or other appropriate state agencies, medical societies, specialty societies, and the Federation of State Medical Boards to develop accurate, state-based, physician-profiling systems.
The GAO report "National Practitioner Data Bank: Major Improvements Are Needed to Enhance Data Bank’s Reliability" is available on the Web at www.gao.gov/new.items/d01130.pdf. ▪