Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large,
Robert A. Dowling, MD, discusses how the National Practitioner Data Bank can inform urologists about the prevalence and type of medical malpractice payments and adverse actions against health care providers in the U.S.
The National Practitioner Data Bank (NPDB) was established more than 30 years ago by Congress because of a perception that quality improvement and medical malpractice had become nationwide problems too big to manage at the state level (bit.ly/npdbguidebook). The Health Care Quality Improvement Act of 1986 called for the creation of a national database “to protect peer review bodies from private money damage liability and to prevent incompetent practitioners from moving state to state without disclosure or discovery of previous damaging or incompetent performance” (www.npdb.hrsa.gov/).
In this article, I will describe how the NPDB works, how urologists may be impacted, and how the data in the NPDB can inform urologists about the prevalence and type of medical malpractice payments and adverse actions against health care providers in the U.S.
What must be reported
The NPDB is overseen by the Department of Health and Human Services and implemented through federal regulations (45 CFR Part 60). The law requires the following actions to be reported by an eligible entity within 30 days to the NPDB and any similar state authority: malpractice payments; licensure and certification actions; negative actions or findings by a federal or state licensing or certification authority, peer review organization, or private accreditation entity; health care-related criminal convictions; health care-related civil judgments; exclusions from federal or state health care; and other adjudicated actions or decisions (bit.ly/npdbinfo).
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NPDB records are broadly categorized as malpractice payments or adverse actions. In addition to reporting requirements, the law also defines when and how health care entities (chiefly hospitals) must request information (chiefly when a health care practitioner applies for a position on the medical staff and every 2 years thereafter). Finally, the regulations describe which subsets of information are available upon request to other persons, entities, or agencies. Statistical information on deidentified data is available on the NPDB website and forms the basis of some of this article (bit.ly/npdbdatafile).
Physicians who find themselves the subject of a report to the NPDB will be notified and given an opportunity to dispute the accuracy of the information in a process defined in regulations. The ultimate decision about the accuracy of the report and whether it should be removed or altered rests with the Secretary of Health and Human Services.
Large urology practices that have a formal process for peer review may meet the definition of an eligible reporting entity and should be familiar with the definitions of adverse actions and clinical privileges in order to understand whether they have a duty to report group member physicians to the NPDB; very few records in the NPDB are the result of a group medical practice report (see below). Consult with your health care attorney.
What are the chances of being reported to the NPDB? It is not possible to calculate lifetime risk from the publicly available data, but we can view absolute numbers by license type and year of reporting. Since inception, 770,759 unique health care practitioners have one or more records (any type) in the NPDB.
In the early 1990s, many of my colleagues predicted that, sooner or later, “everyone” would be in the NPDB. That prediction has, so far, proven unfounded: 222,859 allopathic physicians (MDs) and 17,204 osteopathic physicians (DOs) have records in the NPDB for all years. In 2016, there were 953,695 actively practicing MDs and 102,137 DOs; for the 5-year time period (2014-’18) surrounding 2016, there were 47,847 unique MDs (about 5% of 2016 census) and 4,557 DOs (about 4.5% of 2016 census) in the NPDB (bit.ly/physiciancensus; bit.ly/ompdata).
It appears the risk of allopathic and osteopathic physicians being reported in the NPDB is still low. Reporting peaked for MDs in 2000 and since then has gradually decreased; DO reporting has been relatively flat. The NPDB does not collect information on specialty.
Next: What are the most common reasons allopathic and osteopathic physicians are reported to the NPDB?What are the most common reasons allopathic and osteopathic physicians are reported to the NPDB? For the years 2014-’18, malpractice payments (44,373) outnumbered adverse action reports (38,139). The NPDB offers unique detail on the incidence and economics of malpractice payments in this country. The most common allegations resulting in malpractice payments are shown in table 1. Failure to diagnose is the most common allegation resulting in a malpractice payment for the years 2014-’18, totaling almost $4 billion for that 5-year period.
Failure to monitor is also a common allegation resulting in payment; urologists may recognize this as a potential risk presented by patients lost to follow-up, missed lab and radiology results, and other implied duties of the physician/patient relationship.
Settlement payments are far more common than judgments resulting from trial (table 2). The NPDB also offers detail on the outcome of cases in which there were payments: For MDs and DOs, the most common outcome was death, followed by significant permanent injury (table 3).
Adverse actions taken against MDs and DOs, the second type of report in the NPDB, are slightly less common than malpractice payments. These actions are most commonly reported by a Health Care Practitioner Licensing Board/Authority or State Composite Board (71%), a hospital or acute care facility (6.7%), the Drug Enforcement Agency (5.6%), and others (16%). Group Medical Practices are among the least common reporting entities in the NPDB, with only four reports (0.1%) of adverse actions over a 5-year period (2014-2018). Most of the adverse actions reported for physicians are categorized as indefinite (55%) or permanent (24%).
Bottom line: The NPDB is nearing its 30th anniversary of operation, and a minority of practicing physicians are recorded in the data. Hospitals are the main consumer of this information and use it for routine credentialing purposes. The publicly available malpractice payment data can aid urologists and others in understanding the incidence and type of malpractice events resulting in payment and the importance of risk management in the contemporary practice of medicine.