National Practitioner Data Bank Guidebook Explained


An entry in the National Practitioner Data Bank (NPDB) can end a doctor’s career permanently. It is critical for doctors to understand how this works, and patients ought to know what it means. In the winter 2018 issue of the Journal of American Physicians and Surgeons, Lawrence Huntoon, M.D., Ph.D, summarizes the key points in the new 239-page Guidebook to the NPDB.

The NPDB was created by the Health Care Quality Improvement Act of 1986 (HCQIA) for the purpose of preventing “bad doctors” from simply moving to another place where no one would know of their history. Malpractice payments and “adverse actions”—”any negative action or finding”—taken by a licensure board, law enforcement agency, peer review organization, accreditation organizations, or clinical privileging entities such as hospitals must be reported. All reports remain there permanently unless withdrawn by the reporting entity.

Before a hospital grants privileges, it must by law check the NPDB. The Guidebook states that the NPDB is “primarily a flagging system that may serve to alert users that a more comprehensive review of the qualifications and background of a health care practitioner, entity, provider or supplier may be prudent…. NPDB information should not be used as the sole source of verification of professional credentials.”

However, Dr Huntoon emphasizes that hospitals rarely look past the “scarlet letter” of an adverse report in deciding whether to grant or renew hospital privileges.

“NPDB does not make determinations regarding the accuracy of reported information, validity, merit or lack thereof of reported adverse actions,” Dr. Huntoon states. The action may have involved a trivial issue, or even a sham peer review action taken in malicious bad faith in order to remove a competitor.

Physicians need to be aware of what constitutes a reportable event. Many do not know that if they resign their medical staff privileges for any reason while an investigation is ongoing, they must be reported. Once they have resigned, they lose any due-process rights they might have had to defend themselves.

The definition of “investigation” is not clear, Dr. Huntoon warns, and worse, it may be kept secret from the doctor. Physicians should not resign without getting a written statement that they are not under investigation, he advises.

As hospitals are increasingly large corporate entities focused on their bottom line, they are increasingly the adversaries of physicians rather than partners in a healing mission, observes the Association of American Physicians and Surgeons. Thus, physicians who work in hospitals need to be vigilant about requirements of the NPDB.

Read full article:

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.