Special Report: Credentialing
Federal databases are increasing in number
NPDB, HIPDB collect different data
The concept of a centralized database is attractive to many credentialing experts, and a state repository may be a step toward a comprehensive national system. The goal of Florida’s legislation centralizing credentialing, says Lucy Gee at the Florida Department of Health in Tallahassee, "is to get practitioners out from under their redundant paperwork. The state is the repository of the credentialing data, and anyone requiring the information need not go to the practitioner, but to the state." (See related story, p. 1.)
Because the federal government employs many health care providers, its personnel spend much time and effort on credentialing. All facilities use standards of the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, in their processes, and primary source verification is repeated each time a provider applies for membership and privileges at another institution. Duplicated staff time and fees are a waste of resources and tax dollars, and the current system is notoriously slow. Procedures are being developed to permit reciprocal sharing of a credentialing process via access to a centralized database. Demonstration projects are in place in New Mexico, Alaska, and the District of Columbia. It is hoped that linkage of information will:
• promote interagency sharing and national readiness;
• assist in current efforts to establish networks of health care facilities;
• facilitate the establishment of telemedicine initiatives that cross agency or state boundaries.
Already in place is the National Practitioner Data Bank (NPDB), which only contains records on physicians who have had adverse actions taken against them by state medical boards, professional societies, and health care entities, or have had professional liability judgments, settlements, or awards since September 1991. The Health Care Quality Improvement Act originally required eligible entities to report to the bank information regarding medical malpractice payments and adverse actions against physicians.
Two years ago, Medicare and Medicaid sanction information was incorporated into the database. The information collected in the NPDB is considered confidential and is released only to eligible querying entities (for a fee) and to practitioners who wish to see what information is there on themselves. Practitioners may not change the information that has been reported. However, if they believe a report contains inaccurate information, they may dispute the report, add a statement to the report, or both. The NPDB is managed by the Federal Government’s Division of Quality Assurance in the Department of Health and Human Services.
HIPDB info not available to general public
What may not be so familiar to you is the new Healthcare Integrity and Protection Data Bank (HIPDB). The Health Insurance Portability and Accountability Act of 1996 led to its creation. Still in its infancy, HIPDB will be a national health care fraud and abuse data collection program for reporting and disclosure of final adverse actions taken against providers, suppliers, or practitioners. Primarily a flagging system, information from the HIPDB will be available for a fee to federal and state government agencies, health plans, and — via self-query — to providers, suppliers, and practitioners. HIPDB information will be not available to the general public and will be considered confidential. (See table listing who reports what information to the NPDB and HIPDB and who can query the data bank, p. 6.)
Vivian Chen,ScD, MSW, associate director of policy at the Division of Quality Assurance, says hospitals are ineligible for HIPDB as Hospital Peer Review goes to press simply because of an oversight in the legislation. The regulation was open for public comment until late December, so that situation may have been changed by the time you read this article.
"What sets HIPDB apart from the NPDB," Chen says, "is that HIPDB will contain more than peer review actions. It will include criminal convictions and judgments, as well." Data will include state and federal licensure actions not limited to quality issues. "That data is given now in the NPDB as a service, but it’s not officially a part of that legislation," she says.
The Federation of State Medical Boards’ Action Data Bank provides information only on those physicians who have been disciplined by state medical boards.
(Editor’s note: See www.hrsa.dhhs.gov/bhpr/dqa/fedcred.htm and www.hrsa.dhhs.gov/bhpr/dqa/hipmain. htm on the Internet for more information on federal credentialing initiatives. The AMA’s Web site, www.ama-assn.org, contains information on the organization’s credentialing products.)
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