The National Practitioner Databank (NPDB) provides data on medical professional liability payments and adverse actions related to healthcare providers, practitioners, and suppliers. David Lowenstein, NPDB director, spoke with Inside Medical Liability about the role of the NPDB in the medical professional liability industry.
IML: Has the mission of the NPDB changed since its founding in 1986?
Lowenstein: We have three main objectives—to improve healthcare quality, protect the public, and to reduce healthcare fraud and abuse. Our underlying goal has remained the same despite changes to technology and healthcare delivery.
IML: What types of professionals does the NPDB cover?
Lowenstein: We cover all health professionals—physicians, nurses, nurse practitioners, physicians’ assistants, optometrists, podiatrists, physical therapists, respiratory therapists, nursing assistants—really, any human healthcare professional.
IML: How do you carry out your core objectives?
Lowenstein: We primarily do that through the queries to our database from our users. Our primary focus is to make sure that we collect reports, which are not limited to medical malpractice. We also receive reports related to adverse actions taken by various organizations such as state licensing boards, hospitals, health plans, and various federal entities. These adverse actions include judgments and convictions in addition to malpractice or medical liability reports.
Our real goal is to ensure that those who are making hiring and credentialing determinations have the information they need to make the best decisions possible. Almost every application I’ve seen for licensure, for credentialing, or for a job in the medical field has many of the same questions that are contained in an NPDB report.
IML: The NPDB’s reports, then, offer a template for some of the important information that licensing boards, hospitals, and others need to verify?
Lowenstein: Yes, we are a verification tool to make sure that every individual being hired, licensed, or credentialed is not intentionally or unintentionally leaving something out, and to demonstrate that there is a good picture of the history of individuals, which we think helps ensure healthcare quality. We’re not making any decisions—we just provide information so that anyone making decisions can determine if the doctor, nurse, or other professional is the right fit for that license, that job, or that medical staff.
IML: How has the NPDB evolved in terms of technology?
Lowenstein: When we were founded, everything was paper based. It took days or weeks to get responses to the queries that we received. Now, everything is online. We also offer the option that makes it easier for folks to query a number of individuals at a time. We are always seeking to evolve our data quality and the ease of obtaining that data. We also endeavor to do everything we can to protect our data from a cybersecurity perspective.
IML: What is the value of the NPDB amid the ocean of medical professional liability data and data providers?
Lowenstein: We’d like to think that the breadth of our information is of tremendous value because we are the only data source that I know of where there are federal obligations to report both medical malpractice and adverse actions. Anytime I go to a conference and speak about the NPDB, a tremendous number of people come up to me and thank me for the information that we provide that has helped them identify practitioners who weren’t being exactly truthful. We are not the be-all and end-all of healthcare credentialing information. However, we want to make sure that we’re used along with other sources of information that are either required or important or that are useful and that the information we provide is accurate and useful.
IML: How has consolidation in healthcare affected what is reported to the NPDB? Is there a concern that the identities of healthcare providers named in medical professional liability claims may be more difficult to identify?
Lowenstein: Our statutes and our regulations are pretty specific about what's reportable to us. Reportable data must be a payment made by an entity to or for an individual practitioner. We do recognize that there are some situations where a payment may be made that is not reportable to us because it doesn't fit in with that scope and definition. We are consistently looking at issues that might affect the quality or numbers of reports. However, our requirements are laid out in the statute and in regulation, meaning that we really don't have any ability to change those parameters on our own. That would obviously be Congress' purview.
IML: How does the “corporate shield” play into this situation?
Lowenstein: We know there are situations where a corporate shield exists so that the name of an individual practitioner may not get sent in, but rather the corporation name.
There has been a reduction in the number of reports over time and there has been a lot of research done on this as well. I would leave it to the researchers to tease out the reasons behind this, whether it’s the corporate shield, tort reform, or other types of things like apology laws and early alternative dispute resolution methods. Ultimately, our regulations tell us what’s reportable and that’s what we have to go on.
IML: How is the NPDB evolving to serve the needs of its users?
Lowenstein: Our focus now is on making sure our data quality remains high. Over the last decade, we’ve increased our compliance efforts in the area of data quality, which is of potentially great benefit to the medical community and public at large.
We are always looking for improved ways to capture the information that is reported with the least amount of burden on the public, on the medical liability community, and the medical community in general. Our goal is to always improve our tools while keeping costs as low as possible for those who query us.
IML: How has your focus on data quality and compliance affected your data?
Lowenstein: We began our efforts about a decade ago, really focusing on state medical board actions and looking more closely at the reporting behaviors of state licensing boards. While it is ultimately the responsibility of those entities to report, we work closely with medical boards and do some comparisons to make sure they are doing what they are supposed to do.
Three or four years ago we began an attestation effort with an educational focus to make sure that required reporters understand what the rules are and providing all the necessary information. We’ve rolled that attestation effort out to different groups including health plans and hospitals, medical malpractice payers, and all other reporting entities so that everyone who reports is also asked to attest to their reporting behavior and our confidentiality provisions.
IML: How do you see the NPDB evolving in the future?
Lowenstein: From a systems perspective we continue to focus on data quality, ease of use, and cybersecurity. Over the next few months, we will conduct a user survey, something that we do every few years. We’re hoping to get a good response from our users, as well as those who self-query, so that we can learn about their recommendations for improvement and aspects of the NPDB that they believe are working well. We are hoping that the survey will give us some insight so that we can make appropriate changes. I’m not aware of any particular changes coming from Congress, but certainly, if they send anything our way, we’d adapt as quickly as possible.
From a system's perspective, again, we're going to focus on data quality and ease of use for folks. Cybersecurity, of course, is going to be important.
IML: How might stakeholders more effectively and efficiently use the data provided by the NPDB?
Lowenstein: We always want our users to query more. Hospitals are the only organizations required by federal law to query. Other organizations might have to query to meet accreditation standards or to participate in a particular program. We encourage organizations who can query us—medical liability providers are not allowed to query the NPDB—to use our continuous querying service, which is available by subscription.
This service not only tells them the information that we have available currently on a particular provider or practitioner, but other information that comes along over the next days, weeks, or months we would then disclose almost immediately back to the querying entity. To the extent that an organization has providers on staff or is licensing providers, our continuous querying service is a great tool to make sure that you get the latest information as quickly as possible without having to wait until the next time you conduct credential renewals.
With medical malpractice payments, for example, it can be years between an adverse event and a payment being made. That means the report won’t include that information until the payment is made. However, if there are licensure actions coming in from other states, some kind of criminal conviction, or an exclusion from Medicare or Medicaid, an organization can find out about it almost immediately through this service.