Information in the data bank that is available to eligible entities or those wishing to self-query their accounts includes medical malpractice payments, adverse actions related to licensure, changes in clinical privileging, professional society review actions of its members, Drug Enforcement Administration actions, and exclusions from federal health care programs (eg, Medicare and Medicaid). The totality of the guidelines can be viewed online at www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp.
What Must Be Reported to NPDB?
- Medical malpractice payments
- Federal and state licensure and certification actions
- Adverse clinical privileges actions
- Adverse professional society membership actions
- Negative actions or findings by private accreditation organizations and peer-review organizations
- Health care–related criminal convictions and civil judgments
- Exclusions from participation in a federal or state health care program (including Medicare and Medicaid exclusions)
- Other adjudicated actions or decisions
Although the 2018 guidelines do not necessarily add novel pathways to end up in the data bank, there are significant clarifications focusing on any “restrictions” in clinical privileges.
Relevant Clarifications in the 2018 Updates
- An agreement to not exercise privileges or surrendering/restricting clinical privileges mandates NPDB reporting.
- Taking a leave of absence while under clinical investigation mandates NPDB reporting.
- Resignation while under a quality review plan (for clinical competence) or a quality review plan that lasts beyond 30 days in duration mandates NPDB reporting.
- Any state licensing or governing board’s adverse action against one of its licensees mandates NPDB reporting.
- Any adverse state licensing or board action that curtails a licensee’s practice of medicine due to mental illness, alcohol, or drug abuse mandates NPDB reporting.
- Surrendering a license, not under investigation, for mental illness, physical illness, or simply entering a substance abuse center is not reportable.
- Payment of a malpractice claim from a physician’s corporate account (PC, PA, PLLC, LLC, etc.) is reportable, while those payments made from their private funds or that of a group practice are not reportable.
In addition to the general inclusion rules noted above, the following are a few more obscure means by which emergency physicians in particular might find themselves included in the data bank.