The October 2018 Updates to the National Practitioner Data Bank Guidebook Expands on Physician Reporting Requirements

Established in 1986, the National Practitioner Data Bank (“NPDB”) is a “repository of reports that contain information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers.” NPDB website. Under the NPDB, hospitals and other entities with peer review committees, health plans, and numerous others are required to report certain adverse actions to the centralized database. Reporting to the NPDB (or failing to report) has serious consequences to both mandatory report entities and practitioners that are reported. Entities that report improperly (or properly), may face lawsuits from reported practitioners. Conversely, reported practitioners who appear on the NPDB (properly or improperly) may have lasting career and reputational effects.

The NPDB Guidebook provides interpretation of NPDB requirements for mandatory report entities. On October 26, 2018, the Guidebook was updated for the first time since April 2015. While many of the October 2018 updates to the NPDB are editorial changes, there were also modifications made regarding what is considered a reportable surrender of privileges, as well as other reporting descriptions. These changes will likely lead to more reporting events.

These changes occurred predominately in Chapter E: Reports, Reporting Adverse Clinical Privileges Actions, with the addition of a new section entitled “Length of Restriction”. This section clarifies that, regardless of how a restriction order is written, if a professional review action affects the privileges of a practitioner in a negative way for longer than 30 days, it is reportable. This update appears to be a response to a 2017 federal court ruling that found that a proctoring restriction was not reportable because it was not clear that the restriction would take more than 30 days.

The October updates also added seven new Questions and Answers to the conclusion of Chapter E: Reports, Reporting Adverse Clinical Privileges Actions. The Q&As clarify the following:

• Q. 22: An agreement not to exercise privileges during an investigation is reportable.
• Q. 23: A leave of absence that restricts privileges during an investigation is reportable.
• Q. 24: Withdrawal of a pending reappointment application may be reportable if any inquiries fall outside of what would be considered a routine review.
• Q. 25: Depending on the requirements of the plan, resignation while under a “quality improvement plan” may be reportable.
• Q. 31: The requirement that a surgeon operate with only a qualified first assistant may be a restriction of privileges and thus reportable if it runs more than 30 days, is imposed on one specific surgeon, and is a professional review action.
• Q. 46: A practitioner’s lapse of privileges at the end of a scheduled term may be reportable if a hearing has not yet been held on a Medical Executive Committee’s recommendation to deny a reappointment application.
• Q. 49: Additional information on whether to revise or void NPDB reports that were modified by Court order.

While the NPDB Guidebook serves only as an informational policy manual for the health care community, it greatly influences the ways in which NPDB reporting should occur.

As in prior editions, the 2018 Guidebook reiterates that the law does not provide for prior notice that any of these circumstances will result in a NPDB report. Hospitals may not realize the need to report certain circumstances. And, physicians may not realize the effect of agreeing to not exercise privileges for a month, or taking a needed leave of absence, if they are not informed they are being investigated. Hospitals and their physicians should consider how they want to approach these matters, and medical staff policies and bylaws should be updated to reflect these changes in order to properly report under the NPDB.

The recently updated National Practitioner Data Bank Guidebook is available in PDF form and for download here.

For more information regarding the NPDB Guidebook and how the changes may affect you or your practice, please contact Adrienne Dresevic, Esq. or Clinton Mikel, Esq.