Other Health Professions Programs

*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.

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:

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.

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.