NPDB Guidebook and Reporting Requirements – One year later

In April 2015, the National Practitioner Data Bank (NPDB) published its first new guidebook in 13 years. It includes a significant expansion of the NPDB’s definition of an investigation with direct impact on reporting requirements for physicians or dentists who resign while under investigation.

The impetus behind the expanded language is seemingly based on troubling statistics of underreporting by healthcare entities and insurers, with only 47% of all hospitals ever filing a report to the Data Bank. In an effort to force change in such practices, the NPDB added language to the new guidebook that represents a significant expansion of the NPDB’s definition of an investigation.

One year later, medical staff leaders, medical services professionals, and healthcare attorneys continue to express strong concerns that the guidebook language, if allowed to stand over time, likely will undermine medical staffs’ ability to conduct effective peer review.

While physician leaders have tolerated poor quality and unprofessional conduct, and often still do, many have stepped up to drive improvements in physician performance. Their success has been achieved through the effective use of measurement, feedback, and active interventions to manage poor performance, escalating physician performance concerns in a collegial manner and driving meaningful change without fear of these activities being reportable. Under the new guidebook language, a physician resigning during such collegial performance improvement processes will be reportable. This may cause physician leaders to shy away from undertaking these important activities.

While it is hoped that collaboration by the NPDB with key stakeholders such as the AMA, AHA, AHLA, Joint Commission, and NAMSS will lead to more moderate guidebook language in the near future, the current guidebook language represents today’s NPDB policy. The Greeley Company’s article, To Report or Not to Report: What to Do about the Recent NPDB Guidebook Update, continues to be one of the most-requested articles. First published in the September 2015 issue of HCPro’s Credentialing & Peer Review Legal Insider, the article provides practical suggestions for navigating the decision of whether to report to the NPDB.

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