Mr. Chairman, I am Thomas Croft, Director of the Division of Quality Assurance in the Bureau of Health Professions, Health Resources and Services Administration. The Division oversees the operation of the National Practitioner Data Bank. I appreciate the opportunity to speak with you today about the Data Bank and the important issues you have raised.
The National Practitioner Data Bank was created in response to the requirements of the Health Care Quality Improvement Act of 1986 and began operation in September 1990 under the most difficult of circumstances. Funding and staffing issues, opposition from many practitioner organizations and an operating system in need of updating were major obstacles to its success. We believe we have overcome these problems, moving from a paper-driven system which often could not respond in 30 days, to a fully electronic system which typically responds in 2 hours.
Today, because of our commitment to customer service and continuous quality improvement, the National Practitioner Data Bank plays a vital role in the important process of practitioner credentialing. It provides verification of sensitive adverse information about practitioners in an efficient and reliable manner, while, at the same time, maintaining the security and confidentiality required by law.
At the beginning of the year the National Practitioner Data Bank held nearly 228,000 disclosable records concerning more than 146,000 practitioners of which more than 100,000 are physicians. In 1999 the Data Bank responded to nearly 3.5 million requests for searches of the data base, more than four times the number in 1991. Those requests resulted in actual disclosures, or "hits," at the rate of about 3.5 per minute during a normal business day. The Data Bank's ability to respond quickly and accurately, and for a relatively modest fee, has not only fueled its success but has made it a model for other government data collection and disclosure efforts.
It is fair to say that the significant growth and success of the Data Bank can be attributed in large part to our efforts to improve the systems which support the Data Bank. However, there is room for improvement in other areas as well. We are refocusing our efforts on improving the practical usefulness of the information in the Data Bank, particularly our efforts to collect information on all actions and malpractice payments which should be reported. For example, certain industry sources told us in 1990 that we should expect hospitals to report more than 1,000 disciplinary actions every month, yet fewer than 1,000 are reported in a year. After almost ten years, more than half of all hospitals have never reported a disciplinary action.
In a 1995 report on this subject the Inspector General of the Department of Health and Human Services cited several reasons which might explain this underreporting, but because of the confidentiality accorded peer review records in hospitals, none could be substantiated conclusively. As a result of that OIG report, a forum of industry leaders was held in Chicago in 1996, at which there was general agreement that underreporting is an unfortunate reality. However, the continuing absence of wholly reliable data makes it more difficult to assess the extent of the problem so that useful solutions can be formulated.
Accordingly, the Health Resources and Services Administration (HRSA) will soon contract with an accounting firm to help us devise, and execute, a plan for auditing hospital records so that required data can be efficiently collected and analyzed. The Department is also considering a recommendation by the Inspector General to seek a legislative change which would provide for monetary penalties in instances where hospitals had demonstrably failed to report reportable actions.
Another important issue raised by Congressman Bliley concerns disclosing Data Bank information to the public. As you know, the Secretary, in her response to Mr. Bliley on this subject said: "The issue of disclosing to the public information contained in the NPDB is complex. On one hand, I agree with your assertion that consumers need more information in order to make educated decisions regarding the medical professionals whose treatment they may wish to seek. On the other hand, ... there are privacy concerns regarding broad public disclosure of potentially incomplete negative information."
In fact, Mr. Chairman, the statute and the regulations under which NPDB operates are very clear. In the nearly ten years of HRSA management diligence has been exercised to ensure the confidentiality mandated by the the law . You have previously heard testimony on various sides of this multi-faceted issue from earlier witnesses. HRSA would only caution that any changes in the law be carefully considered and further debated, with due attention to what may be significant privacy implications, before being enacted. Without a doubt, there are legitimate arguments on both sides of opening up NPDB which ought to be considered. However, it is the data bank managers' opinion that the key is not in the data itself, but in how it is used. Currently, for example, when a practitioner applies for employment or for admitting privileges, the hospital asks the practitioner for a complete practice history including any malpractice payments or adverse actions. A query of the Data Bank then verifies the information about malpractice payments and adverse actions for the hospital, or it discloses information to the hospital which the practitioner may have failed to include in the application.
In either case it ensures that the practitioner can not move from place to place in the hope of escaping a checkered past. That is precisely the purpose of the Act.
Nothing in the Data Bank's information, on the other hand, is intended to produce an independent determination about the competency of an individual practitioner. It rather is intended to supplement a comprehensive and careful professional peer review. It is noteworthy that the vast majority of practitioners who have reports listed in the Data Bank have only one and that is almost always a malpractice payment report. It is impossible and unfair to conclude from a single malpractice payment report alone, or even in some cases from numerous malpractice payment reports, anything substantive about the competence of a practitioner. To do so would be a disservice to all parties involved. At the same time, it is easy to understand the public's frustration with the lack of entirely accurate and unbiased information, particularly when some licensing authorities are slow to act in the face of practitioners' histories of poor and occasionally shoddy medical practices.
In conclusion, Mr. Chairman, I believe that by almost any account the National Practitioner Data Bank has been a success. However, there is room for improvement, to which we remain committed. To a great degree, the Data Bank's successful beginning is due to the Congress. We welcome your suggestions for better service and will work closely with you on these. Mr. Chairman, this concludes my remarks. I am happy to address your questions.
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