Administrators in Medicine Annual Meeting NPDB Update for Medical Board Executives April 22, 2015 David Loewenstein Compliance Branch Chief U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce Division of Practitioner Data Bank

General Provisions Reporting and Querying Details Reporting and Querying Overview Reporting Details Reporting – Key Topics Report Subjects Obtaining NPDB Reports Querying Details NPDB Compliance NPDB Guidebook Research Tools Demonstration Reporting Compliance Screenshots Resources Contact Information Presentation Overview 2

General Provisions

Purpose Created under three statutes to meet several needs: Flagging system for effective credential reviews Protection against unfit practitioners Deter fraud and abuse in the health care system General Provisions 4

Merger Goal Eliminate duplication between the NPDB and HIPDB The 3 statutes-- Title IV of Public Law , Section 1921 of the Social Security Act, and Section 1128E of the Social Security Act -- remain in effect ONE data bank ONE set of regulations governing the NPDB’s operations General Provisions 5

Types of Information Collected Medical malpractice judgments, settlements Adverse licensing, certification actions Clinical privileges actions Health plan contract terminations Professional society membership actions Negative actions/findings from private accreditation organizations and peer review organizations Government administrative actions, e.g., exclusions from programs Civil & criminal health care-related judgments 6 General Provisions

Types of Transactions Reporting (no charge) Querying (by hospitals and health care organizations) $3 for a one-year continuous query subscription $3 for a one-time query Fees lowered October 1, 2014 Self-Query (by an individual or organization) $5 Fee lowered October 1, General Provisions

Recovering Costs By law, the NPDB must recover the full cost of operations. It does so by collecting fees for each query. Confidentiality Information reported to the NPDB is confidential, not available to the general public, and may not be disclosed except as provided by law. Penalty up to $11,000 per confidentiality violation. 8 General Provisions

Reporting and Querying Details

10 Required Not Authorized Optional Reporting and Querying Overview

State Licensing and Certification Agencies Must report on: Practitioners, providers, and suppliers  Adverse licensure and certification actions  Any dismissal or closure of a formal proceeding by reason of surrendering the license or leaving the state/jurisdiction  Any other loss of license or right to apply for or renew  Any publicly available negative action or finding, excluding fines and/or corrective actions unless connected to health care delivery or taken in conjunction with another action 11 Reporting Details

Denials of Initial or Renewal Application  Reportable if denied based on formal proceedings  Not reportable if threshold criteria not met  For initial only – withdrawal of application while being investigated, for any reason, is not reportable Withdrawal of Renewal During Investigation  Reportable regardless of reason Voluntary Surrenders  Report surrenders made after notification of an investigation or formal official request 12 Reporting – Key Topics

Fines & Penalties  Reportable if connected to the delivery of health care or taken in conjunction with another action Stayed Actions  Report the part, if applicable, that is not stayed Summary/Emergency/Non-Final Actions  Report interim cessation of practice during investigation (includes voluntary), emergency/summary suspensions 13 Reporting – Key Topics

Alcohol and Drug Treatment  Reportable: A practitioner enters treatment and a licensure or certification action is taken  Not reportable: If a practitioner enters treatment and no licensure or certification action is taken  To protect confidentiality, the fact that the practitioner entered treatment should not be reported 14 Reporting – Key Topics

Recent System Enhancements  Field of licensure  Cease and desist orders  Actions against authority to prescribe Sufficient Narrative Descriptions  Summarize official findings or state case facts  Describe circumstances that led to action Consent Orders/Agreements  The action, not the method used, determines reportability 15 Reporting – Key Topics

Approximate Number of New NPDB Reports Submitted On Practitioners From 2010 – 2013 by Profession Total: ~403,000 Practitioner Reports 16 Report Subjects

Report Copy Forwarded to State Licensing and Certification Authority  Only certain report types  Medical malpractice payments  Clinical privileges actions  Professional society membership actions  Negative actions or findings by peer review and private accreditation organizations  Only ONE state 17 Obtaining NPDB Reports  Supported by NPDB Report Forwarding tool Querying  Results include ALL reports submitted  Continuous query available

May query on: Practitioners, providers, and suppliers as needed, including when reviewing initial or renewal applications; when conducting an investigation; or when certifying eligibility to participate in government programs State Licensing and Certification Agencies 18 Querying Details

NPDB Compliance

To date, NPDB compliance activities have focused primarily on licensing boards Licensing board process updated in January 2015 Currently shifting attention to other areas, in addition to ongoing licensing board efforts: Medical malpractice Health plans Judgments/Convictions Hospitals Increased focus on improving NPDB registration data and overall data integrity 20 NPDB Compliance

State Board Adverse Action Comparison Impact (As of Dec. 2014) -New Reports are those submitted with effective dates during the time period being reviewed ( ) and concurrent with the compliance effort -New Reports Disclosed represents the number of New Reports that have been disclosed as of December 2014 to queriers -Total Disclosures from New Reports represents the number of times the New Reports have been disclosed as of December 2014 to queriers 21 NPDB Compliance

State Board Attestation Results (as of Dec. 2014) State Board Adverse Action Comparison Results (as of Dec. 2014) -Attestation occurs for each board (including boards not required to register) every two years at registration renewal -Profession refers to state/profession combinations -“Could Not Attest” indicates a statement by the board that it could not attest that all reports have accurately been submitted -“Failed to Attest” indicates the board failed to provide a response for the profession -Review completed for the 12 most queried professions (i.e., nurses, pharmacists, physician assistants, podiatrists, psychologists, social workers, physicians, dentists, chiropractors, optometrists, physical therapists, and behavioral health professionals) in each state. -Allied health professions (e.g., pharmacy technicians, nursing assistants, dental hygienists) were also included. 22 NPDB Compliance

Attestation Required at NPDB registration renewal for all boards licensing or certifying health care professions. Attestation has three parts: Review and update agency’s profile to reflect changes over the last two year period. Profession Verification: agencies review, verify, and update the list of professions they currently regulate. Certification: all agencies attest to their compliance with NPDB reporting requirements for each of their regulated professions. 23 NPDB Compliance

Audit of Board Actions One-to-one audit of all professions representing 80% of query volume Physicians (MD and DO) Dentists Physician Assistants Advanced Practice Nurses Registered Nurses Social Workers Random selection of all other professions Sample drawn every two years Any other profession or board may be audited at the discretion of HRSA 24 NPDB Compliance

NPDB Guidebook

26 NPDB Guidebook Release – Spring 2015 NPDB Guidebook

What the new Guidebook does: Blends HIPDB and NPDB to reflect new combined regulations Adds Section 1921 Provides policy clarification What the new Guidebook does NOT do: Make revisions that require legislative or regulatory changes Accept or address every recommendation made by commenters. NPDB Guidebook 27

Research Tools Demo

Reporting Compliance Screenshots

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Help When You Need It FAQs, Brochures, and Fact Sheets National Practitioner Data Bank Guidebook Recorded Webinars Instructions for Reporting and Querying Regulations Statistical Data Research Tools The NPDB Newsletter NPDB Customer Service Center NPDB Compliance Tip Line Resources

David Loewenstein Compliance Branch Chief Division of Practitioner Data Bank Bureau of Health Workforce Health Resources and Services Administration U.S. Department of Health and Human Services Telephone: Contact Information