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2018 National Practitioner Data Bank Guidebook Image

2018 National Practitioner Data Bank Guidebook

Posted by: Ryan C. Ellis

On October 26, 2018, the Health Resources and Services Administration (HRSA) updated its National Practitioner Data Bank (NPDB) Guidebook for the first time in over three years. This is the guidebook that, among other information, provides guidance regarding reporting requirements that may affect a physician’s status and privileges. Although the previous version of the NPDB Guidebook remains largely intact, there are a few important updates and clarifications that address reporting requirements that are new to the 2018 edition.

Agreements Not to Exercise Privileges: Previously, a physician’s formal surrendering of his or her privileges while under investigation was reportable. The 2018 NPDB Guidebook clarifies that even informal agreements not to exercise privileges are reportable.[1]

Leaves of Absence: A leave of absence while under investigation that restricts (or has the effect of restricting) privileges must be reported. If a practitioner takes a leave of absence that does not affect privileges during that leave, it is not reportable. This update should be considered along with Agreements Not to Exercise Privileges above; a leave of absence with an informal agreement or understanding that a practitioner will not be exercising privileges during a leave of absence is reportable.[2]

Review of Reappointment Application: Routine or general reviews are not reportable. If, however, there are specific concerns about a practitioner’s competence due to the number or severity of medical malpractice cases, then an inquiry into a reappointment application deviates from routine review and is likely reportable. This is because a non-routine inquiry is likely to be considered an “investigation” by NPDB standards. If a practitioner resigns during a non-routine review, that resignation would also be reportable. [3]

Quality Improvement Plans: A quality improvement plan is reportable if it: (1) restricts a practitioner’s clinical privileges, (2) is the result of a professional review action (3) concerns the practitioner’s professional competence or conduct, and (4) is in place longer than 30 days. In addition, if a quality improvement plan includes a warning that a practitioner may be disciplined if the plan is not followed, and the plan could be considered an investigation, then any resignation during the course of the plan would be reportable.[4]

Requirements on Surgeons: If all new surgeons are required to operate only in the presence of a qualified first assistant, the requirement is not reportable. If, however, the requirement is imposed on a specific surgeon as the result of a professional review action related to competence and conduct, and the restriction remains in effect for more than 30 days, then the requirement is reportable.[5]

Reappointment Term Lapses: If a current clinical privileges appointment ends during an ongoing inquiry or investigation stemming from a recommendation that a physician not be reappointed to another term, but before a hearing or final action, the lapse in reappointment is reportable.[6]

Length of Restriction: The new Guidebook clarifies that when a professional review action adversely affects the privileges of a practitioner for longer than 30 days, it is reportable. This is true regardless of how the restriction is worded.[7]

Proctoring: If a proctoring arrangement restricts a practitioner’s privileges as a result of a professional review action, and lasts longer than 30 days, it is reportable, no matter how the proctoring order is written. For example, a proctor must be present for a practitioner’s next 10 surgeries, and it takes longer than 30 days to complete 10 surgeries, then the arrangement is reportable. This is a clarification from the previous Guidebook.[8]

Importantly, the rule that no report is necessary if a settlement is made on behalf of a named business or corporation with multiple practitioners remains intact. The NPDB regulations specifically acknowledge that, “[A] payment in settlement of a medical malpractice action or claim shall not be construed as creating a presumption that medical malpractice has occurred.” Section 60.7(d). No Medical Malpractice Payment Report to the NPDB is necessary unless a practitioner is named, identified, or described in both the written complaint or claim demanding monetary damages, and the settlement release or final adjudication. Examples of descriptions that are sufficient to meet this definition include “chief of surgery” and “the doctor who participated in the patient’s surgery.” As such, even these relatively vague identifiers should be left out of settlement language in order to avoid necessitating a report.

This information is general in nature and should not be construed as tax or legal advice.

[1] NPDB Guidebook p. E-50.
[2] Id.
[3] Id. at p. E-50-51; (“Investigation” is interpreted broadly by the NPDB; and is considered to run from the start of an inquiry until a final decision on a clinical privileges action is reached.)
[4] NPDB Guidebook p. E-51; (Practitioner’s should look to the Bylaws of their workplace to see if it includes a definition of “investigation.” Although the NPDB makes the ultimate determination as to whether an inquiry or action constitutes an investigation, it also takes an organization’s Bylaws into consideration.)
[5] NPDB Guidebook p. E-53.
[6] Id. at p. E-57.
[7] Id. at p. E-40.
[8] Id.