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Other Health Professions Programs
Healthcare Integrity and Protection Data Bank
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FY
2007
Actual |
FY
2008
Enacted |
FY
2009 Estimate |
FY
2009 +/-
FY 2008 |
BA |
($3,825,000)* |
($3,758,000)** |
|
(-$3,758,000) |
FTE |
6 |
6** |
|
-6 |
*Estimates include user fees plus supplemental HCFAC
funds from the OIG as necessary.
**If Section 1921 is not implemented by the end of
the second quarter of FY 2008, we anticipate funding
at $3,758,000 to continue, i.e., user fees, HCFAC
funds. As previously specified, HRSA has already officially
requested $1,500,000 allocation to supplement an anticipated
HIPDB users fee collection of $2,258,000 in FY 2008.
Authorizing Legislation: Title II, Subtitle C of the
Health Insurance Portability and Accountability Act
of 1996 (HIPAA) (P.L. 104-191), establishes Section
1128E of the Social Security Act.
FY
2009 Authorization |
Indefinite
|
Allocation
Method |
User
Fee Program |
Program Description and Accomplishments
Title II, Subtitle C of the HIPAA establishes Section
1128E of the Social Security Act. The purpose of Section
1128E is to prevent or reduce fraud and abuse and
improve quality in health care. Section 1128E directs
the Secretary of Health and Human Services, acting
through the Office of Inspector General (OIG), to
establish a program to collect, maintain and report
final adverse actions taken against health care practitioners,
providers and suppliers. This information is collected
from and made available to Federal and State government
agencies and health plans. The Healthcare Integrity
and Protection Data Bank (HIPDB) was designed to collect,
maintain, and distribute this information and opened
for reporting on November 22, 1999 and for queries
on March 6, 2000.
Through an agreement with the OIG, HRSA is responsible
for the development and operation of the HIPDB. Final
policy decision-making remains with the OIG. The HRSA
received allocations from the Health Care Fraud and
Abuse Control (HCFAC) account for the development
of the HIPDB system, which is modeled after the National
Practitioner Data Bank (NPDB). All operating costs
are paid by user fees and allocations by the OIG from
the HCFAC account. There is no appropriation for the
HIPDB.
The HIPDB provides critical information to State and
Federal agencies, law enforcement officials, and health
plans concerning adverse licensure and contract actions;
health care related civil judgments; and, criminal
convictions against health care practitioners, providers
and suppliers. This information helps prevent practitioners,
providers and suppliers from moving from State-to-State
without disclosure of prior acts. In addition, it
helps law enforcement officials in the battle against
health care fraud and abuse.
Since March 2000, the HIPDB processed 7,147,056 queries
from health plans, State and Federal agencies. Of
these, health plans submitted 77 percent. Also of
these, 3,700 queries were provided to the Centers
for Medicare and Medicaid Services and the Department
of Veteran Affairs as well as other Federal agencies
such as the Department of Health and Human Services’
Office of the Inspector General.
The length of time it takes the NPDB-HIPDB to process
a query and return results to the querier has been
reduced while both the number of queries and the number
of reports in the system have continually increased.
When the NPDB opened in 1990, it took days to process
queries. The system has changed from paper documents
to an internet-based system containing electronic
documents. Queries are now responded to within 240
minutes. The volume of queries has increased greatly
over the years, to over 4.7 million queries in FY07.
Program Assessment Rating Tool: An
Office of Management and Budget (OMB) Program Assessment
Rating Tool (PART) assessment of the HIPDB was conducted
in 2006 and the program received a rating of Moderately
Effective.
The PART review noted that:
The program purpose is clear and the program is designed
to have a unique and significant impact. By providing
a single source of information regarding all malpractice
payments, clinical privileges, health plan action
or professional society membership information, the
Data Banks can assist entities in making critical
staffing decisions regarding health care professionals.
The review also noted that the program is well managed.
It ensures that entities submitting inquiries to the
Data Banks are served promptly and uses performance
information to improve both operations and customer
service.
The program has some limitation on its ability to
maximize its efficiency and effectiveness. According
to the law, the Data Banks have some restrictions
on organizations that are able to make inquiries about
health care practitioners.
In FY 2006, HRSA awarded a contract to conduct a new
national survey of NPDB and HIPDB users and non-users
to gauge user satisfaction, use of data bank information,
and opportunities for improvement. Work on the survey
began during FY 2007 and results are expected in FY
2009.
A draft of the final rule for implementation of Section
1921 had been formulated and is currently, as of January
17, 2008, at the Department of Health and Human Services
for final approval.
Section 1921 will add licensure actions on all types
of health care practitioners and health care entities
to the NPDB, making this critical information available
to hospitals on a national basis from a single source.
In FY 2007, 1,300 licensing or credentialing decisions
were impacted by information supplied by the HIPDB.
This is about 9 percent above the target. In 13,150
cases the querying entity considered the information
provided by HIPDB to be useful. This is about 8 percent
above the target level.
Funding History
HIPDB user fees collected (revenue)
The table below shows the user fees collected during
the last five years:
FY
2004 |
$4,238,314 |
FY
2005 |
$4,270,720 |
FY
2006 |
$4,000,000 |
FY
2007 |
$3,825,000 |
FY
2008 |
$3,758,000 |
Budget Request
There is no FY 2009 budget request for the HIPDB.
With the implementation of Section 1921 in FY 2008
there will be little unique information available
from the HIPDB. The FY 2009 legislative proposal would
sunset HIPDB and move the unique HIPDB reports not
covered by Section 1921 into the NPDB by amending
Section 1921. This will effectively move HIPDB revenue
and associated costs into the NPDB. It is anticipated
that this additional NPDB revenue will fund all additional
government and contractor costs associated with the
legislative proposal. Remaining HIPDB funds, and/or
funding from other sources will cover the costs of
the sunset (i.e., programming and operational changes).
HIPDB user fees are established to conform exactly
to NPDB user fees on a cost per query basis.
Operational costs of the HIPDB include:
a.
Data Bank Operations Contract
-
Responding to requests for information and assistance
-
Receiving and encoding information into the data
bank
-
Providing information to individuals who query the
data bank about themselves
-
Providing systems enhancements to make the Data
Bank more accessible to users
- Providing
support for fee collection
- Maintaining
interactive access through the Internet for transmitting
reports and requests for information
b. Data Bank Operations - Non-contract
- Oversight
of data bank operations and systems security
- Federal
contract management
- Periodic
contract re-competition
-
Development and interpretation of Data Bank program
policy
- Printing
of program informational and marketing materials
-
Management of a system to resolve disputes (Secretarial
Review process) about the accuracy of Data
- Bank
information
- Development
of specifications for Data Bank systems enhancements
- Management
of a research capability based on Data Bank information
- Management
of a continuous quality improvement program
- Fee
collection
Although fees are established based on query volume
to result in adequate, but not excessive, revenues
to pay all program costs, HIPDB fees at the same level
may not provide enough revenue to pay all allocated
HIPDB costs. This is because the HIPDB report to query
ratio is much higher and because Federal agencies
do not pay HIPDB query fees, as provided by law. Consequently,
the Department of Health and Human Services augments
HIPDB query fee revenue, as needed, with Health Care
Fraud and Abuse Control (HCFAC) funds. There is a
direct relationship between the total of user fee
revenue collected, as augmented by HCFAC funds, and
the program’s ability to meet performance goals.
HRSA will continue to strive to meet HIPDB performance
goals through outreach and education to State licensing
boards, health plans, and law enforcement. In addition
the program will continue to try and maintain a HIPDB
reserve that is equal to one-half of HIPDB’s
annual operating cost. However, with the implementation
of Section 1921, the HIPDB will not be able to financially
sustain its own existence. Therefore, the HIPDB will
continue to require additional HCFAC/OIG funding in
order to maintain its existence until it can be properly
shutdown and all HIPDB functionality that exist throughout
the highly complex NPDB-HIPDB system can be phased
out. HRSA has already officially requested an FY 2008
HCFAC allocation of $1,500,000 to meet on-going HIPDB
contract obligations, to account for the likely loss
of revenue expected to occur during FY 2008, and to
initially support/fund the projected HIPDB Sun-setting/merger
Legislation.
Inadequate HIPDB operating revenues would mean that
new reports and queries could not be processed promptly
and queriers would not receive responses in time for
them to affect licensing and credentialing decisions.
Further, since the HIPDB fee per query decreases or
increases with the NPDB fee, adjustments in the amount
of HIPDB funding are made through modifying the allocation
from the HCFAC funds.
#
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Key
Outcomes |
FY
2004 Actual |
FY 2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target
|
Actual
|
Target |
Actual
|
Long-Term Objective : Improve
the quality of health care |
8.III.B.3 |
Increase annually the use of
the HIPDB for licensing and credentialing decision-making,
operationalized as the number of licensing and
credentialing decisions which limit practitioner’s
ability to practice because of information contained
in NPDB reports. (Baseline – 2005: 1,120
Decisions) |
1,000 Decisions
|
1,120 Decisions |
1,155 Decisions
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1,150 Decisions |
1,190 Decisions
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1,300 Decisions
|
1,225 Decisions
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NA |
NA |
8.III.B.4 |
Increase annually the number
of times of information provided by HIPDB is considered
useful by the querying entity which received it.
(Baseline 2005 - 11,400) |
10,200 |
11,400 |
11,750 |
11,650 |
12,100 |
13,150 |
12,450 |
NA |
NA |
# |
Key
Outputs |
FY
2004 Actual |
FY 2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target
|
Actual
|
Target |
Actual
|
Efficiency Measure |
8E |
Increase annually the number
of queries for which NPDB and HIPDB responded
within 240 minutes |
4,329,000 |
4,414,000 |
4,611,000 |
4,549,800 |
4,701,100 |
4,701,600 |
4,792,000 |
NA |
NA |
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Appropriated Amount ($ Million
- user fees and supplemental funds from the OIG
as necessary) |
($4.238) |
($4.270) |
|
($4.000) |
|
($3.825) |
($3.758) |
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NA – Not Applicable because no separate funding
is proposed. With the implementation of Section 1921
in FY 2008 there will be little unique information
available from the HIPDB. The FY 2009 legislative
proposal would sunset HIPDB and move the unique HIPDB
reports not covered by Section 1921 into the NPDB
by amending Section 1921. This will effectively move
HIPDB revenue and associated costs into the NPDB.
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