Other Health Professions Programs

Authorizing Legislation: Section IV, P.L. 99-660; Health Care Quality Improvement Act of 1986, as amended by P.L. 100-177; Section 5, Medicare and Medicaid Patient Protection Act of 1987
(P.L. 100-93), and Omnibus Budget Reconciliation Act of 1990 (P.L. 100-508).

Program Description and Accomplishments
The Health Care Quality Improvement Act of 1986 (HCQIA) Title IV of Public Law 99-660 was enacted to enhance the quality of health care, encourage greater efforts in professional peer review and to restrict the ability of incompetent health care practitioners to move from State to State without discovery of previous substandard performance or unprofessional conduct. Title IV led to the creation of the National Practitioner Data Bank (NPDB) to collect and disclose certain information related to the professional competence and conduct of physicians, dentists, and other health care practitioners.

The NPDB is primarily an alert or flagging system whose principal purpose is to facilitate peer review. As a nationwide flagging system, it provides another resource to assist State licensing boards, hospitals and other health care entities in conducting independent investigations of the qualifications of the health care practitioners, they seek to license, hire, contract, or to whom they wish to grant clinical privileges. The NPDB was designed for the receipt, storage and dissemination of the following types of information: (1) paid medical malpractice judgments and settlements against all licensed health care practitioners, (2) boards of medical examiners adverse actions against State licensure, (3) hospital and other health care entities adverse actions against clinical privileges (medical staff membership), and (4) professional societies adverse action against membership. Consequently, insurance companies as well as any payor of a medical malpractice claim for the benefit of any licensed health care practitioner; State licensure authorities for physicians and dentists; and professional societies are required to report their adverse actions to the NPDB.

The appropriations legislation for FY 1993 and all subsequent years require that user fee collections cover the full cost of NPDB operations, therefore, there is no appropriation for operating the NPDB.

With the proposed implementation of reporting called for in Section 1921 of the Social Security Act, a majority of the information that is currently reported to the Healthcare Integrity and Protection Data Bank (HIPDB) will be reported to the NPDB. This will create substantial duplication of information for release between the NPDB and the HIPDB. Consequently, in the FY 2008 Budget we proposed that these two programs be merged into one program—the NPDB. We are again proposing this merger in the FY 2009 Budget. The HIPDB currently provides critical information to State and Federal agencies, law enforcement officials, and health plans concerning adverse actions against healthcare practitioners, providers, and suppliers. The types of HIPDB reportable actions include adverse licensure actions as well as health care related civil judgments and criminal convictions of 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, the disclosure of this information aides law enforcement officials in the battle against health care fraud and abuse in the delivery and provision of health care and services. Once Section 1921 is implemented the vast majority of this information will be available in the NPDB.

As a result of continual efforts to maximize advancement in information technology, on May 1, 2007, the Data Banks (NPDB and HIPDB) introduced and executed the Proactive Disclosure Service (PDS) Prototype. With this service, all eligible entities that choose to register their practitioners with the NPDB and/or the HIPDB will be notified of new reports that name any of their registered practitioners as subjects within 24 hours of the Data Banks' receipt of the report. This service will be offered in addition to the traditional Data Bank querying service. While the method and timing of delivery will change, the format and the information contained in a Data Bank report, as well as the information required to be reported to each Data Bank will remain the same.

The Data Banks and Data Banks’ customers favor this service because it will, in effect, continuously query on enrolled practitioners. The PDS service has the potential of improving the quality of health care and patient safety by ensuring that entities that credential, license, and/or employ health care practitioners are alerted of the existence of a reported adverse action or medical malpractice payment immediately. Data Banks research has shown that an average of 302 days lapse between the receipt of information (report) and the receipt of a request (query) for that information with the traditional query method. The PDS service eliminates that delay.

In addition, PDS has been recognized and approved by the Joint Commission, the National Committee for Quality Assurance, and the Centers for Medicare & Medicaid Services as an acceptable method to access information from the NPDB for entity practitioner credentialing and on going monitoring processes.

This new initiative keeps the Data Banks on the forefront of technology by providing customers a choice in services. The PDS has already been recognized by Government Computer News as one of the Top 100 Federal and private sector programs having Athe greatest impact on the government information systems community in 2005.@ This is the third major award the Data Banks have won for information technology achievements in the last four years.

In FY 2007, the NPDB underwent several technology enhancements to improve system availability, performance and security. These enhancements included:

a.	Implemented the Earned Value Management System (EVMS) and applied it throughout the full contract life-cycle. This EVMS will allow HRSA to better track how the project is proceeding in terms of its budget and schedule and alert management of any shortfalls and potential problems.
b.	. Added a Timely Reporting Compliance Notice to the Report Verification Document (RVD) that a reporter receives from the NPDB at the time they submit a report. This was done in an effort to remind reporting entities of their obligation to report their actions within 30 days of the date that they took the action.
c.	Implemented a web-based interface for users to register and maintain their registration every two years, which will greatly reduce the time and resources (paper) needed by the Data Banks and the user to renew registration. The Data Banks serves approximately 16,000 registered users.
d.	Enhanced entity/agent Data Banks capabilities by enabling the agent to submit both queries and reports on behalf of the entity as long as the entity has statutory authority to submit both queries and reports.
e.	Posted the NPDB-HIPDB privacy policy on all IQRS online services.
f.	Added the ability for reporter to correct a Revision-to-Action Report.
g.	Increased report narrative and subject statement fields from 2,000 to 4,000 characters.
h.	Provided entities with the capability to search for queries and reports submitted since June 2000.

Program Assessment Rating Tool: An Office of Management and Budget (OMB) Program Assessment Rating Tool (PART) assessment of the NPDB 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 inquires 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 addition, NPDB technical enhancements that are planned for the future include implementation of Section 1921 of the Social Security Act, which will expand the current NPDB as referenced above.

In FY 2007, 47,200 licensing or credentialing decisions were impacted by information supplied by the NPDB.
This exceeded the target by more than 3 percent. In 479,500 cases the querying entity considered the information provided by NPDB to be useful. This exceeded the target by about 5 percent.

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.

Funding History

NPDB user fees collected (revenue)

As mandated by the HCQIA, the NPDB does not receive appropriated funds. Instead, the NPDB program is financed by the collection of user fees. The table below shows the user fees collected during the last four years and the projected amount for FY 2008:

*Based on the assumption of the implementation of Section 1921 during FY 2008.

Budget Request
Because of the statutory mandate to operate on collected user fees, there is no FY 2009 budget request for the NPDB. Based on the assumption that Section 1921 will be implemented at the end of the second quarter of FY 2008, the NPDB user fee collections will be $18,900,000.

User fees are established at a level to cover all program costs to allow the NPDB to meet short and long term program performance goals. Fees are established based on query volume that will result in adequate, but not excessive, revenues to pay all program costs.

Since 1990, user fees have changed due to increases and decreases in query volume. In FY 2006, the NPDB received 3,646,544 queries. The level of querying activity is only expected to increase slightly through FY 2008 if Section 1921 is not implemented. The target for FY 09 is 4,322,177 queries. However, if Section 1921 is implemented, the level of querying activity should increase by approximately 20 percent.

Operational costs of the NPDB 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

NA – Not Applicable