American Health Lawyers Association: 2015 NPDB Webinar Q&A Responses

On June 15, 2015, staff from the National Practitioner Data Bank hosted a webinar with members of the American Health Lawyers Association (AHLA). AHLA provided a list of questions prior to the webinar and later prioritized the questions on this list to those that could be addressed in the hour allotted. The remaining questions are addressed in this document.

Q1: Since the three Databases are now combined, when a hospital (or other entity) queries the NPDB, will it automatically get all information that has been reported to the NPDB regardless of the statutory predicate for reporting?

A1: Table D-1 on pages D-3 and D-4 of the NPDB Guidebook and text on pages D-7 and D-8 detail what information entities can receive when they query the NPDB. When querying, entities receive what information they are entitled to under the authorizing statutes that govern the NPDB.

Q2: With respect to the Question No. 3 from the Guidebook pages E-40 and E-41, the Guidebook states that withdrawal of an application before a Board makes a decision is not reportable unless under an investigation. The entire appointment process focuses on the physician's background, training, education, etc. If a physician becomes aware that some questions about his qualifications have been raised, but again no final decision is made, and then withdraws his application, is this reportable? This again gets to the question of what is an investigation.

A2: Generally, the appointment process would be considered a routine review that does not rise to the level of an investigation; however, there may be times when specific competency concerns come up that require additional, concentrated review of an applicant. A hospital that considers a specific review of a particular application based on competency concerns to be an investigation, would need to demonstrate support for this in bylaws and other hospital documents

Q3: To clarify Question No. 40 on page E-52 of the Guidebook, would the answer be different if the temporary privileges, if granted, would only have lasted 6 months but the physician withdrew the application because of questions related to his competency?

A3: It depends. If the process for examining the application for temporary privileges was still routine according to the hospital's standards, then this is not reportable. However, if the application review had already veered into non-routine territory and was now an investigation, then the withdrawal of the application would be reportable. It is also reportable if the application review was about to become an investigation, but the physician withdrew his application in order to avoid the investigation. Each health care entity would be responsible for defining the limits of a routine application review versus an investigation.

Q4: Please discuss the reporting obligations when a physician goes on leave to enter a drug/alcohol treatment program:

1. Voluntary leave of absence with a self-referral to the program.
2. Summary suspension of 10 days, followed by voluntary leave of absence and self-referral to the program.
3. Summary suspension of more than 30 days, with referral to the program.

A4: The reporting obligations are:

1. Variable. Taking a leave of absence or self-referring to drug or alcohol treatment are not reportable events, either separately or combined. If the physician voluntarily surrenders or restricts clinical privileges in order to avoid an investigation or professional review activity while on the leave of absence, then the voluntary surrender/restriction would be reportable.
2. Variable. If the summary suspension ends on day 10 and the practitioner then takes a leave of absence, the answer in part (a) applies. If the practitioner takes the leave of absence during the 10 day summary suspension and the summary suspension is considered an investigation, then the leave of absence would be reportable as resigning during an investigation.
3. Reportable. A summary suspension of more than 30 days is reportable as a restriction of clinical privileges lasting more than 30 days. The fact that the practitioner was referred to or entered a treatment program is not reportable.

Q5: Question No. 4 on page E-41 of the Guidebook states that the denial of expanded privileges should be reported if based on competency issues. The response should be clarified. Privileges can be denied for many reasons tied to competency. For example, the NPDB states that if denied because the physician has not met a threshold criterion, such as performing a required number of procedures, this is not a reportable event. I am assuming that the response was intended to address the situation where a physician's record suggests that they are not competent based on a history of questionable care that would place patients at risk of the privilege was granted but this point is not very clear.

A5: Threshold criteria determinations are different than inquiries into a practitioner's competence or conduct. Although it's understood that an application review process is used to assess all of an applicant's qualifications which include competence and conduct, threshold criteria are basic eligibility requirements. Examples given on page E-33 of the Guidebook include minimum professional liability coverage, board certification, geographic proximity to the hospital, and performance of a minimum number of procedures as threshold criteria.

An applicant may be denied for privileges because she doesn't have the proper experience (i.e. hasn't met the requirement of a certain number of procedures), and the denial would not be reportable as it was based on threshold criteria. Contrast this with a situation where the applicant is denied because of history of failing to adequately conduct a procedure. This denial could be considered related to the competence of the applicant and would be reportable.

To the extent that a decision to deny an application is based on competency concerns, and not eligibility requirements, then that denial is reportable.