1. Is it Time to Rewrite the Healthcare Quality Improvement Act of 1986?
Kathy Matzka, CPMSM, CPCS, LLC

2. Why it Was Enacted
Increasing occurrence of medical malpractice and the need to improve the quality of medical care
A national need to restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician’s previous damaging or incompetent performance
Promote physicians to participate in effective professional peer review
This “nationwide problem can be remedied through effective professional peer review.”

3. So….How are We Doing?
Using NPDB data, physicians at Brigham and Women's Hospital analyzed the trends in paid medical malpractice claims for physicians in the US from 1992 to 2014
From to , the rate of paid physician claims decreased by 55.7%
After adjusting for inflation, amount of the payment increased by 23.3%
Percentage of payments exceeding $1 million increased
Researchers noted that NPDB does not include data about claims for which no payment was made and those settled on behalf of institutions
Source: Rates and Characteristics of Paid Malpractice Claims Among US Physicians by Specialty, JAMA Internal Medicine May 2017 Volume 177, Number 5

4. Physicians Advocacy Institute Study 2018
From July 2014 to July 2016, over 40,000 physicians shifted into employment models
From July 2015 to July 2016, the number of physicians employed by hospitals grew by 14,000 Nationwide
42% of physicians were employed by hospitals in July 2016, compared to just one in four physicians in July 2012
Between July 2012 and July 2016, the number of physician practices employed by hospitals grew by 36,000 practices; a 100% increase over four years
Source: Updated Physician Practice Acquisition Study: National and Regional Changes in Physician Employment , Physicians Advocacy Institute

5. NPDB Sanctions/Disciplinary Action Through 2017 - Physicians Only
Action Type
Physician (MD)
Physician (DO)
Row Total
State Licensure
89,996
9,951
99,947
Clinical Privileges/Panel Membership
19,018
1,513
20,531
Professional Society Membership
991 32
1,023
Drug Enforcement Administration
2,699
318
3,017
HHS OIG Exclusion
7,511
498
8,009
Total
132,527
Singh, Harnam. National Practitioner Data Bank. Action Type by Practitioner Type. Generated using the Data Analysis Tool at  Data source: National Practitioner Data Bank (2017): Adverse Action and Medical Malpractice Reports ( )

6. Problems????
Hospitals settling doctors out of lawsuits, so no NPBP medical malpractice report
Hospitals contracts with physician employees include “clean sweep provision” - employed physician agrees to waive all fair hearing and appeals rights in lieu of hospital’s employment termination grievance process – so no NPDB report

7. Problems???
The Act requires reporting of adverse actions taken against “physicians” MD, DO, DDS, DMS
“Permissive reporting” on other licensed health care practitioners if the entity would be required to report such information if the practitioner were a physician
If peers are hospital employees, is there a problem with “good faith” peer review? Will doctors be afraid to go against the employer?
Reporting of a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days

8. Potential Fixes????
Med mal reports to NPDB in the name of a health care practitioner on whose behalf the malpractice payment is made regardless of whether or not the practitioner is named as a defendant in the claim or whether or not the hospital settles them out of the claim
Professional Review Action = report for anyone who has medical staff appointment or clinical privileges and report regardless of length of action
Giving all practitioners who have adverse privileging actions option for medical staff hearing, regardless of contract, with option of having impartial outsiders on hearing panel in the case of hospital with all employed physicians

9. Discussion