NPDB 101 Teleconference

The NPDB 101 Teleconference was held on September 23, 2020.

Event materials: Teleconference Presentation Slides (PDF - 700 KB).

Q&As

When is an investigation reportable?
In the context of clinical privileges actions, investigations themselves are not reportable to the NPDB; an action resulting from an investigation is reportable if it meets NPDB reporting requirements. In addition, a surrender of clinical privileges or failure to renew clinical privileges while under investigation or to avoid investigation must be reported.
The NPDB interprets the word "investigation" expansively, although the investigation must be related to a specific practitioner's professional competence or conduct. An investigation begins as soon as the entity starts a non-routine inquiry. It does not end until the authority's decision-making body takes a final action or makes a decision to not further pursue the matter.
What if physicians do not know they are being investigated for possible clinical privileges actions? Are their resignations during investigations reportable?
Yes. There is no requirement that health care practitioners be notified or be aware of the investigation, although the reporting entity should be able to produce evidence that an investigation was initiated prior to the surrender of clinical privileges by practitioners.
When does peer review become reportable?
Peer review by itself is not reportable; the actions taken as a result of a peer review are what may be reportable. If a negative action is taken that meets NPDB reporting requirements, that action must be reported.
A routine, formal peer review process under which a health care entity evaluates, against clearly defined measures, the privilege-specific competence of all practitioners is not considered an investigation for the purposes of reporting to the NPDB. However, if a formal, targeted process is used when issues related to a specific practitioner's professional competence or conduct are identified, this is considered an investigation for NPDB purposes.
After conducting a professional review of a surgeon's competence, a hospital assigned a surgical proctor for 45 days. The surgeon could not perform surgery without being granted approval by the surgical proctor. Is the hospital required to report this action to the NPDB?
Yes. Since the surgeon cannot practice surgery without approval from the proctor, this restriction of clinical privileges, for more than 30 days, must be reported.
Because of quality of care concerns, our hospital took a privileging action against a doctor that lasted only 30 calendar days. Is the action reportable?
For NPDB purposes, a hospital's action must last more than 30 calendar days for it to be reportable. In this situation, since the privileging action lasted only 30 days, it is not reportable.
Should follow-up actions to NPDB reports — such as the lifting of a suspension — be reported to the NPDB?
Yes. To notify the NPDB of follow-up actions, the reporting entity should submit a Revision-to-Action Report. A Revision-to-Action Report modifies an adverse action report previously submitted to the NPDB. A Revision-to-Action Report does not replace a previously submitted adverse action report but, rather, is treated as a separate reported action that pertains to the previous action. Both reports become part of the disclosable record. The entity that reports an initial adverse action also must report any modification of that action.
Note, however, that if an adverse action report indicates that a suspension will be lifted after a specified length of time, and the suspension is lifted in accordance with that schedule, no additional report needs to be submitted.
When an entity submits a report on a practitioner, how much detail should be included in the narrative?
A narrative in a report should contain sufficient detail that entities receiving the report understand what is alleged to have happened. The narrative should summarize the official findings or state the facts of the case and include a description of the circumstances that led to the action taken.
How long does it take for a report to be listed in the NPDB once it's been submitted?
The report will be available within 1 business day. However, most are available in near real time.
If an entity discovers that a practitioner should have been reported but was not, can the entity report the practitioner?
Yes. In fact, the filing of late reports is required. The law say reports must be filed within 30 days of when an action is taken or a medical malpractice payment is made, but if a report is filed outside that time frame, we still accept the report. Future queriers of that practitioner should have access to that information.
What happens when organizations do not report as required?
It depends upon the type of action. As we learn of what wasn't reported, we inquire and generally either the entity submits the report or provides an acceptable explanation why the action was not reportable to the NPDB. If entities don't submit reportable actions, ultimately they could be fined, lose the good faith immunity granted for their peer review activities by Title IV of the Health Care Quality Improvement Act of 1986, have their responsibility to report transferred, or have their failure publicly identified.
If a hospital is self-insured, what are the reporting requirements for medical malpractice claims?
Self-insured entities have the same reporting responsibilities as all other medical malpractice payers. Entities that are self-insured and provide their health care professionals with professional liability coverage must report medical malpractice payments they make for the benefit of their professionals, provided NPDB's criteria for reporting medical malpractice payments are met, such as the requirement that the payment be made in response to a written claim or judgment for medical malpractice.
Is there a minimum payment amount in order for a medical malpractice payment to be reportable?
No. The payment of any amount in a situation that otherwise meets NPDB reporting requirements must be reported.
Who is responsible for reporting a medical malpractice payment arising from a settlement?
The party that makes the payment is responsible for reporting it. If there are multiple primary parties that contribute to a payment, all are required to report. The reports should describe the basis for the individual parties' payments to avoid the impression of duplicate reporting.
Are NPDB reports available to the general public?
No. Reports filed with the NPDB are considered confidential and are not disclosed except as specified in NPDB statutes and regulations. Entities receiving information from the NPDB may disclose that information to others who are part of an investigation or peer review process, as long as the information is used for the purpose for which it was provided.
Is there a requirement to query the NPDB before employing a registered nurse at a health care organization?
It depends. Hospitals must query whenever anyone, no matter the discipline, applies for medical staff appointment or clinical privileges, and every 2 years on anyone on its medical staff or who holds clinical privileges. Hospitals may query whenever they are considering hiring a health care professional.
Other health care entities are not required by federal law to query, but they have the ability to do so in certain circumstances, depending upon the type of entity. For example, health plans may query:
- When determining the fitness of individuals to provide health care services
- When protecting the health and safety of individuals receiving health care through services they administer
- When protecting the fiscal integrity of programs they administer
Should a hospital query on retired medical staff who remain staff members but do not have clinical privileges?
Yes. Each hospital must request information from the NPDB when a physician, dentist, or other health care practitioner applies for medical staff appointment (courtesy or otherwise) or for clinical privileges at the hospital, including temporary privileges, and every 2 years on all physicians, dentists, and other health care practitioners who are on its medical staff (courtesy or otherwise) or who hold clinical privileges at the hospital. So if retired individuals remain members of the medical staff, even if they do not have clinical privileges, the hospital is required to query on them.
How does Continuous Query work with reappointments? When a practitioner is enrolled in Continuous Query, does the entity need to run a query at reappointment?
As long as a practitioner is actively enrolled in Continuous Query, the entity would not have to run a separate One-Time Query at reappointment because the NPDB is continuously monitoring the practitioner. To maintain a practitioner in Continuous Query, the Continuous Query enrollment must be renewed annually. You have the option to renew enrollments manually or automatically. If you renew manually, you will receive a reminder email 2 months before an enrollment expires.
Can there be more than one Data Bank administrator at a time?
Yes, organizations may have more than one administrator. Administrators are responsible for maintaining the organization's profile and creating and maintaining user accounts for all individuals in the organization who query or report.
How many authorized users can be registered for each entity?
There is no limit on the number of authorized users that can be registered; however, only active users should be allowed to access the NPDB system for querying or reporting purposes. If a user leaves or no longer has a business need to access the system, the Data Bank administrator should disable the user's account.
I am a doctor, how do I know if I have a report in the NPDB?
The NPDB mails a notification of any report filed to the subject of the report. In addition, all health care practitioners can perform a self-query. To find out more, see the Self-Query FAQs on the NPDB website.
Can a hospital require practitioners to submit a Self-Query instead of querying on the practitioners itself?
If a hospital wants to require a practitioner to submit a Self-Query, the NPDB cannot stop it from doing so. However, the hospital itself still needs to query on practitioners as required by federal law. A hospital cannot avoid its querying obligations by requiring a practitioner to submit a Self-Query.
Are there any restrictions on what a practitioner can do with a Self-Query report?
Once a practitioner receives a Self-Query report, the practitioner is free do with it what the practitioner wants. We are aware that some entities who may not be eligible to query the NPDB require practitioners to submit Self-Query reports to them. We do not have authority to stop this practice. Whether the practitioner submits the Self-Query report to the requesting entity is up to the practitioner.
How does a practitioner who is the subject of an NPDB report dispute the report?
The subject of a report may add a Subject Statement to the report at any time. The Subject Statement becomes part of the report and remains with the report unless the subject of the report edits or removes it. In addition, at any time the subject of a report, or a subject's designated representative, may dispute the report and enter the report into Dispute Status to disagree with the factual accuracy of the report, to challenge whether the report was submitted in accordance with NPDB reporting requirements, or both. However, entering the report into Dispute Status does not trigger a review of the report by the NPDB. To request a review of the report by the NPDB, the subject of the report must request that the report be entered into Dispute Resolution. The NPDB will review the report for factual accuracy and whether it was submitted in accordance with NPDB reporting requirements only after:
- The subject of the report has entered the report into Dispute Status
- The subject has waited 60 days after entering the report into Dispute Status, during which the subject has attempted to contact the reporting entity to resolve the issues raised by the report
- The subject has verified this effort, and
- The subject has requested Dispute Resolution
How can I obtain statistical reports? What kind of data are available to the public?
The NPDB collects data on medical malpractice payments; adverse licensure, clinical privileges, and professional society membership actions; Drug Enforcement Administration actions; and Medicare and Medicaid exclusion actions, among other types of negative actions. These reports involve physicians, dentists, other licensed health care practitioners, and health care entities. Selected variables from these reports can be found in our Public Use File and our Data Analysis Tool, both available on the NPDB website. Neither the Public Use File nor the Data Analysis Tool contains information that allows identification of individuals or health care entities.
If researchers cannot find the information they need in the Public Use File or the Data Analysis Tool, they can make arrangements to obtain additional information from the NPDB. Requests for such arrangements can be made by email.

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