GAO urges reform for practitioner data bank
The Department of Health and Human Services has no plan to address the problems of underreporting to the National Practitioner Data Bank (NPDB), even though its Office of Inspector General (OIG) has long considered that the Achilles heel of the entire process. That’s the conclusion of the General Accounting Office (GAO), which recently released its findings to Congress.
Unfortunately, Congress probably won’t be able to do much to rectify these problems until next year. Earlier this year, House Committee on Commerce Chairman Tom Bliley (R-VA) introduced legislation that would open the NPDB to public scrutiny via the Internet. It would also give the public access to disciplinary information about adverse actions plus additional information to compare physicians within a particular specialty or a given state. But that bill is likely dead, concedes committee spokesman Pete Scheffield.
"As long as there is a breath of life in this Congress, I suppose there is a chance something could happen," Scheffield says. "If not, we hope this report helps [things along] so that somebody picks up the torch next year." One thing is certain: Bliley won’t be leading the charge. He retires at the end of this session.
Health care attorney Mark Kadzielski, of Los Angeles-based Akin Gump, says the GAO report is "absolutely correct that the [NPDB] is a very flawed mechanism" that needs to be improved.
However, the GAO says Health and Human Services (HHS) efforts to quantify or minimize underreporting have been largely unsuccessful. For example, the GAO says the agency has focused on the underreporting of malpractice payments even though OIG- and HHS-sponsored studies conclude that underreporting of clinical privilege restrictions by hospitals and other health care providers is a more pressing issue.
"The problem in credentialing is that just because you don’t get any information from the data bank, that does not automatically mean that the doctor is a qualified professional," says Kadzielski. "There may be many reasons that information is not in there. Unfortunately, it is the only mechanism that exists nationally that has this kind of data."
The GAO also points out that HHS has failed to implement a 13-year-old law that expanded the NPDB to include information on nurses and other health care practitioners.
"As a result, disciplinary actions taken against nurses and other practitioners are not reported to the NPDB, despite these individuals’ increasing importance in the delivery of health care," the GAO argues.
The Chicago-based American Medical Association (AMA) says the GAO’s report merely confirms its view that the NPDB is "riddled with duplicate entries, inaccurate data, and incomplete and inappropriate information."
Even as the NPDB struggles to fulfill its mandate, states continue to move ahead in their ability to collect and disseminate useful information about physicians, the AMA contends. The association points out that information about physician credentials and disciplinary action is available right now through state-based systems.
HHS agreed with the GAO that it needs to improve compliance with reporting requirements. But it balked at the agency’s recommendation to develop procedures to ensure the accuracy and completeness of NPDB information and that it should revise its notification to users regarding limitations in the data.
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