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Other Health Professions Programs
National Practitioner Data Bank
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FY
2007
Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
($16,200,000) |
($18,570,000) |
($18,900,000) |
(+$330,000) |
FTE |
20 |
22 |
30 |
8 |
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).
FY
2009 Authorization |
Indefinite
|
Allocation
Method |
User
Fee Program |
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:
FY
2004 |
$15,008,552 |
FY
2005 |
$15,230,396 |
FY
2006 |
$15,700,000
|
FY
2007 |
$16,200,000 |
FY
2008* |
$18,570,000
|
*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
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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
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Providing systems enhancements to make the Data
Bank more accessible to users
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Providing support for fee collection
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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
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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
# |
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.1 |
Increase annually the use of the NPDB 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: 44,500 Decisions) |
43,800 Decisions |
44,500 Decisions |
45,025 Decisions |
46,450 Decisions |
45,550 Decisions |
47,200 Decisions |
46,075 Decisions |
46,600 Decisions |
2013: 48,700 Decisions |
8.III.B.2 |
Increase annually the number of times information
provided by NPDB is considered useful by the querying
entity which received it. (Baseline – 2005: 451,400)
|
444,200 |
451,400 |
456,100 |
475,300 |
456,300 |
479,500 |
475,300 |
475,300 |
2013: 489,000 |
# |
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 |
Efficiency Measure |
8.III.B.1 |
Increase annually the number of queries for
which NPDB and HIPDB responded within 240 minutes |
4,239,000 |
4,414,000 |
4,611,000 |
4,459,800 |
4,701,100 |
4,701,600 |
4,792,000 |
4,883,000 |
NA |
8.III.B.2 |
Appropriated Amount ($ Million - user fees collected) |
($15.009) |
($15.230) |
|
($15.700) |
|
($16.200) |
(18,570) |
($18,900) |
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NA – Not Applicable
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