Data Analysis Tool

Data Collection

The National Practitioner Data Bank (NPDB) routinely collects information relating to medical malpractice payments and certain adverse actions taken by hospitals and other health care entities, professional societies, health plans, peer review organizations, private accreditation organizations, Federal and State licensing and certification authorities, and certain other Federal and State agencies. More information about the NPDB can be found in About Us. The report level data used in this data analysis application reflect medical malpractice payment and adverse action information, including state licensure and certification actions, clinical privileges/panel membership and professional society membership actions, and HHS/OIG and DEA actions. The term "unique practitioner" is used under the NPDB Practitioners tab to denote the following: one practitioner can be counted in multiple types and in multiple states, which would cause a summation of either category to be greater than the actual unique practitioner count.

Legislation and Regulations

The Health Care Quality Improvement Act of 1986 (HCQIA), as amended, Title IV of Public Law 99-660 (42 U.S.C. 11101 et seq.), led to the establishment of the National Practitioner Data Bank (NPDB). Title IV authorized the NPDB to collect and disclose to authorized queriers certain information relating to the professional competence and conduct of physicians, dentists, and other health care practitioners. Subsequent laws later expanded the information collected and disclosed by the NPDB and modified its operations. Most recently, Congress passed Section 6403 of the Patient Protection and Affordable Care Act of 2010, Public Law 111-148 to eliminate duplication between the NPDB and the Healthcare Integrity and Protection Data Bank (HIPDB). On May 6, 2013, NPDB operations were consolidated with those of the former HIPDB. As a result of this consolidation, information previously collected and disclosed by the HIPDB is now collected and disclosed by the NPDB. This legislation established the NPDB as the single Data Bank to receive and disclose information collected under Title IV, Section 1921 of the Social Security Act, and Section 1128E of the Social Security Act. Information is available to eligible entities based on the requirements of each law. As of May 6, 2013, this Data Analysis Tool contains practitioner reports received by the NPDB and includes state licensure and certification actions, clinical privileges/panel membership and professional society membership actions, and HHS/OIG and DEA actions.

Information reported to the NPDB is confidential and can be provided only to authorized queriers, based on their eligibility to receive the information under each of the three laws. Authorized queriers include hospitals, other health care entities with formal peer review, professional societies with formal peer review, quality improvement organizations, health plans, state licensing and certification authorities, Federal licensing and certification agencies, state law enforcement agencies, state agencies administering State health care programs, state Medicaid Fraud Units, agencies or contractors administering Federal health care programs, U.S. Comptroller General, Federal law enforcement agencies and officials, health care practitioners and health care entities, providers and suppliers (self-query), and plaintiff's attorney/pro se plaintiffs (under limited circumstances).

Under section 426 of the HCQIA (42 USC 11135), as implemented by regulations at 45 CFR part 60.13(a)(2)(ix), data may be released to "a person or entity who requests information in a form which does not permit the identification of any particular health care entity, physician, dentist, or other health care practitioner." This information is released in accordance with that provision to facilitate research use of NPDB information by persons interested in medical malpractice, licensing, discipline, and quality assurance issues.

Limitations of the Data

• Data for 1990 reflect only reports submitted on or after September 1, 1990.
• Data include reports for the 50 States, the District of Columbia, Puerto Rico, the Armed Forces, and other territories.
• Data limitations exist for various practitioner types based on the historical data reporting requirements that are described above.
• Data for this application are based on the most recent full calendar year processed by NPDB for report purposes.
• Analyses resulting from this annually-updated application may not match those obtained from the Public Use File, which is updated quarterly. The data are aggregated using variables not available in the Public Use File.

The following vocabulary and terminology are associated with the National Practitioner Data Bank (NPDB) and apply to the NPDB, its policies, and procedures.

Adverse Action Report (AAR) - the report format used to submit actions, other than medical malpractice payments and convictions and judgments, taken against a health care practitioner, entity, provider, or supplier. AARs in this Data Analysis Tool reflect actions against health care practitioners only.

Adversely affects - reduces, restricts, suspends, revokes, or denies clinical privileges or membership in a health care entity.

Authorized agent - an individual or organization that an eligible entity designates to query the NPDB on its behalf. In most cases, an authorized agent is an independent contractor to the requesting entity (for instance, a county medical society or state hospital association) used for centralized credentialing. An authorized agent cannot query the NPDB without designation from an eligible entity.

Authorized submitter - an individual empowered by an eligible entity to submit reports or queries to the NPDB. The authorized submitter certifies the legitimacy of information in a query or report submitted to the NPDB. In most cases, the authorized submitter is an employee of the eligible entity (such as an Administrator or Medical Staff Director).

Board of Medical Examiners - a body or subdivision of such body that is designated by a State for licensing, monitoring, and disciplining physicians or dentists. This term includes boards of allopathic or osteopathic examiners, a composite board, a subdivision, or an equivalent body as determined by the State.

Clinical privileges - privileges, membership on the medical staff, and other circumstances (including panel memberships) in which a physician, dentist, or other licensed health care practitioner is permitted to furnish medical care by a health care entity.

Dentist - a doctor of dental surgery, a doctor of dental medicine, or the equivalent who is legally authorized to practice dentistry by a State, or who, without authority, holds himself or herself out to be so authorized (includes residents).

Department of Health and Human Services (DHHS) - the Federal Government agency responsible for administering the NPDB.

Drug Enforcement Administration (DEA) - the Federal Government agency that registers practitioners to dispense controlled substances and assigns practitioners Federal DEA Numbers.

Formal peer review process - the conduct of professional review activities through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing.

Freedom of Information Act (FOIA) - the law that provides public access to Federal Governmental records.

Health Care Practitioner, Licensed Health Care Practitioner, Licensed Practitioner, or Practitioner - defined in NPDB regulations as “an individual who is licensed or otherwise authorized by a state to provide health care services (or any individual who, without authority, holds himself or herself out to be so licensed or authorized).”

Health Care Quality Improvement Act of 1986, as amended - Title IV of Public Law 99-660; legislation intended to improve the quality of medical care by encouraging hospitals, State Licensing Boards, and other health care entities, including professional societies, to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of incompetent practitioners to move from State to State without disclosure or discovery of the practitioners' previous damaging or incompetent performance.

Health care entity - (1) a hospital; (2) an entity that provides health care services and follows a formal peer review process for the purpose of furthering quality health care; or (3) a professional society or a committee or agent thereof, including those at the national, State, or local level, of physicians, dentists, or other health care practitioners, that follows a formal peer review process for the purpose of furthering quality health care.

Hospital [as described in Section 1861(e)(1) and (7) of the Social Security Act] - an institution primarily engaged in providing, by or under the supervision of physicians, to inpatients (1) diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or (2) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and, if required by State or local law, is licensed or is approved by the agency of the State or locality responsible for licensing hospitals as meeting the standards established for such licensing.

Inflation Adjusted - the inflation adjustment uses the Bureau of Labor Statistics June 2017 seasonally adjusted (SA) CPI-U, US City Average, All Items. For 1990, we use the September figure. For all other years , we use the June figure to compute the inflation factor that is applied to each payment range.

Medical malpractice payer - an entity that makes a medical malpractice payment through an insurance policy or otherwise for the benefit of a practitioner.

Medical malpractice payment - a monetary exchange as a result of a settlement or judgment of a written complaint or claim demanding payment based on a physician's, dentist's, or other licensed health care practitioner's provision of or failure to provide health care services, and may include, but is not limited to, the filing of a cause of action, based on the law of tort, brought in any State or Federal Court or other adjudicative body.

Medical Malpractice Payment Report - the format used by medical malpractice payers to report a medical malpractice payment made for the benefit of a physician, dentist, or other health care practitioner.

Occupation/Field of Licensure Codes - a list of occupational activities/licensure categories for health care practitioners, providers, and suppliers, and the codes used to identify them.

Physician - a doctor of medicine or osteopathy who is legally authorized to practice medicine or surgery by a State, or who, without authority, holds himself or herself out to be so authorized (includes residents and interns).

Other Territories - includes American Samoa, Marshall Islands, Virgin Islands, Northern Mariana Islands, Palau, Federated States of Micronesia and Guam. Data for Puerto Rico is listed separately.

Practitioner Type - grouping used to classify practitioners into a fixed number of nominal groups to facilitate analysis. The practitioner grouping for each type along with the associated NPDB Public Use File licensure codes are summarized in the following table:

Note: * Practitioners that do not have a Field of Licensure listed are not included.

Privacy Act - the law that establishes safeguards for the protection of Federal systems of records the Government collects and keeps on individual persons.

Professional review action - an action or recommendation of a health care entity:

• (1) taken in the course of professional review activity;
• (2) based on the professional competence or professional conduct of an individual physician, dentist, or other health care practitioner which affects or could affect adversely the health or welfare of a patient or patients; and
• (3) which adversely affects or may adversely affect the clinical privileges of the physician, dentist, or other health care practitioner.

The term professional review action excludes actions which are primarily based on:

• (a) the physician's, dentist's, or other health care practitioner's association, or lack of association, with a professional society or association;
• (b) the physician's, dentist's, or other health care practitioner's fees or the physician's, dentist's, or other health care practitioner's advertising or engaging in other competitive acts intended to solicit or retain business;
• (c) the physician's, dentist's, or other health care practitioner's participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis;
• (d) a physician's, dentist's, or other health care practitioner's association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional; or
• (e) any other matter that does not relate to the professional competence or professional conduct of a physician, dentist, or other health care practitioner.

Professional review activity - an activity of a health care entity with respect to an individual physician, dentist, or other health care practitioner:

• (1) to determine whether the physician, dentist, or other health care practitioner may have clinical privileges with respect to, or membership in, the entity;
• (2) to determine the scope or conditions of such privileges or membership; or
• (3) to change or modify such privileges or membership.

Professional society - an association of physicians or dentists that follows a formal peer review process for the purpose of furthering quality health care.

Query - a request for information submitted to the NPDB by an eligible entity or authorized agent.

Report - record of a medical malpractice payment or adverse action submitted to the NPDB by an eligible entity.

Secretary - the Secretary of Health and Human Services.

Section 1128E of the Social Security Act - enacted as Section 221(a) of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. One of the three enabling statutes underlying the NPDB. Reports collected under Section 1128E are not included in this Data Analysis Tool.

Section 1921 of the Social Security Act - enacted as Section 5 of the Medicare and Medicaid Patient and Program Protection Act of 1987, Public Law 100-93. One of the three enabling statutes underlying the NPDB.

Self-query - a subject's request for information contained in the NPDB about himself or herself.

State - the 50 States, the District of Columbia, Puerto Rico, the Armed Forces, and other territories. In this tool, state is defined as the reporting entity state for state licensure actions. For clinical privileges actions in Federal agencies, state is defined as the practitioner's work state. For non-Federal clinical privileges actions, state is defined as the reporting entity state. If work state is not available, then the practitioner's home state is used. If both work state and home state are unavailable, then the practitioner's license state is used. For all other reports, including medical malpractice payment reports, state is defined as the practitioner's work state. If work state is not available, then the practitioner's home state is used. If both work state and home state are unavailable, then the practitioner's license state is used.

State Licensing Board - a generic term used to refer to State medical and dental boards, as well as those bodies responsible for licensing, certifying, or otherwise authorizing physicians, dentists, or other health care practitioners to provide health care services. See also Board of Medical Examiners, State Licensing or Certification Authority, and State Medical or Dental Board.

State Licensing or Certification Agency - defined in NPDB regulations as “includes, but is not limited to, any authority of a state (or of a political subdivision thereof) responsible for the licensing or certification of health care practitioners (or any peer review organization or private accreditation entity reviewing the services provided by health care practitioners), health care entities, providers, or suppliers. Examples of such state agencies include Departments of Professional Regulation, Health, Social Services (including State Survey and Certification and Medicaid Single State agencies), Commerce, and Insurance.”

State Licensing or Certification Authority - a State Government body that: licenses, certifies, registers, or otherwise authorizes health care practitioners, entities, providers, or suppliers to provide health care services; and/or certifies physicians, dentists, other health care practitioners, entities, providers, or suppliers for participation in a Federal or State health care program. Examples of such State agencies include departments of professional regulation, health, social services (including State survey and certification and Medicaid single State agencies), commerce, and insurance.

State Medical or Dental Board - a board of medical examiners.

Title IV - Title IV of the Health Care Quality Improvement Act of 1986, Public Law 99-660. One of the three enabling statutes underlying the NPDB.

Unique Practitioner - one practitioner can be counted in multiple types and in multiple states, which would cause a summation of either category to be greater than the actual unique practitioner count.

Year - Adverse Action Reports use the year the action was taken and Medical Malpractice Payment Reports use the year of the payment.