The National Practitioner Data Bank and Your ASC The federally run program prevents practitioners from moving without disclosing previous damaging performance BY DONALD ILLICH

The National Practitioner Data Bank (NPDB) is a fed- erally run program managed by the Health Resources and Services Administration

(HRSA). It is a web-based repository of reports containing information on medi- cal malpractice payments and certain adverse actions related to healthcare practitioners, providers and suppliers. Established by Congress in 1986, the NPDB helps prevent practitioners from moving state to state without dis- closure or discovery of previous dam- aging performance. Its mission is to improve healthcare quality, protect the public and reduce healthcare fraud and abuse in the US.

Registration, Reporting and Querying To be able to submit reports and que- ries to the NPDB, a health care organi- zation must register with the program. Hospitals are required to register with the NPDB to carry out various manda- tory querying and reporting responsibil- ities, but ASCs are only required to reg- ister if they meet the definition of “other health care entities.” Once an ASC registers and is

approved to participate with the NPDB, the ASC is expected to file reports of actions it takes against healthcare prac- titioners, entities, providers and sup- pliers associated with the ASC who do not meet professional standards. Those reports are stored permanently unless modified or removed by the organiza- tion that submitted them. Once registered, an ASC can also

query the NPDB regarding a healthcare practitioner or organization they want to know more about. When an ASC submits a query, the NPDB will release only the information it is lawfully

community health centers, health maintenance organizations, preferred provider

organizations, group prac- tices, rehabilitation centers, nursing facilities, hospices and other health- care delivery models.

Reporting to the NPDB ASCs that register

with NPDB as

allowed to report to that ASC based on that organization’s registration sta- tus and federal law. The reports NPDB issues, like the reports individual enti- ties file with the NPDB, are required to be kept confidential and are not to be made available to the public.

Registration and Entity Type ASCs can register with the NPDB as “other health-care entities,”—the term used for organizations that “pro- vide healthcare services and follow a formal peer review process to fur- ther quality healthcare.” The phrase “provides healthcare services” in this description refers to delivering health- care services through a broad array of coverage arrangements or other rela- tionships with practitioners, either by employing them directly or through contractual or other arrangements. A “formal peer review process” in this context refers to the conduct of pro- fessional review activities through for- mally adopted written procedures that provide for adequate notice and an opportunity for a hearing. In addition to ASCs, “other health- care entities” include health centers,


“other healthcare entities” are required to report professional review actions to the NPDB when those actions adversely affect a physician’s or dentist’s clini- cal privileges for a period of more than 30 days. Actions taken against a phy- sician’s or dentist’s clinical privileges include reducing, restricting, suspend- ing, revoking or denying privileges. These actions also include a healthcare entity’s decision not to renew a physi- cian’s or dentist’s privileges if that deci- sion was based on the practitioner’s pro- fessional competence or professional conduct. Clinical privileges actions are reportable once they are made final by the healthcare entity. Healthcare practi- tioners other than physicians and den- tists, such as physician assistants, may be reported to the NPDB for the same types of actions. Summary suspen- sions lasting more than 30 days also are reportable, even if they are not final. ASCs and “other healthcare” facil- ities must report revisions to previ- ously reported adverse clinical privi- leges actions.

When and What to Query ASCs that are registered and authorized to query NPDB are encouraged to sub- mit queries when confronting scenarios like the following: ■

When they have or may be entering into employment or affiliation rela- tionships with healthcare practitioners

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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