Department  of  Health  and  Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
NATIONAL  PRACTITIONER  DATA  BANK

REPORTS  TO  HOSPITALS:

THEIR  USEFULNESS  AND  IMPACT

@ SERWCE8 
J+  t+ 
-+  -/ 
cmBs  BROm

:$ 
 m 
2  Inspector  General

3

~++ $
APRIL 1995
%>vd3a 
OEI-01-94-OO030  OFFICE  OF INSPECTOR  GENERAL 
The mission of the Office of Inspector General (OIG), as mandatedby Public Law 95-452, as 
amended, is to protect the integrity of the Department of Health and Human Services (HHS) 
programs as well as the health and welfare of beneficiaries served by those programs.  This 
statutorymissionis carried outthrougha nationwidenetworkof audits, investigations,and 
inspections conducted by three OIG operating components: the Office of Audit Services, the 
Office of Investigations, and the Office of Evaluation and Inspections. The OIG also informs the 
Secretaryof HHSofprogramandmanagementproblemsandrecommendscoursesto correct them. 
OFFICE  OF AUDIT  SERVICES 
The OIGSOfficeof AuditServices(OAS)providesall auditingservicesfor HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others.  Audits 
examine the performance of HHS programs and/or its grantees and contractors in carrying out 
their respectiveresponsibilitiesand are intendedto provideindependentassessmentsof HHS 
programs and operations in order to reduce waste, abuse, and mismanagementand to promote 
economy and efficiency throughout the Department. 
OFFICE  OF INVESTIGATIONS 
The OIGSOfficeof Investigations(01) conductscriminal, civil, andadministrativeinvestigations 
of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of unjust enrichment 
by providers.  The investigativeefforts of 01 lead to criminal convictions, administrative 
sanctions, or civil money penalties.  The 01 also oversees State Medicaid fraud control units which 
investigate and prosecute fraud and patient abuse in the Medicaid program. 
OFFICE  OF EVALUATION  AND INSPECTIONS 
The OIGSOfficeof EvaluationandInspections(OEI)conductsshort-termmanagementand 
program evaluations (called inspections)that focus on issues of concern to the Department, the 
Congress, and the public.  The findings and recommendationscontained in these inspection reports 
generate rapid, accurate, and up-todate information on the efficiency, vulnerability, and 
effectivenessof departmentalprograms. 
Thk report was prepared in the Boston Region Office under the direction of Mark R. Yessian, 
Ph.D., Regional Inspector General and Martha B. Kvaal, Deputy Regional Inspector General. 
Project staff included: 
BOSTON REGION  HEADQUARTERS 
David Veroff, Project Leader  Alan Levine, Program Specialist

Joyce Greenleaf, Program Analyst

Barry McCoy, Program Analyst

Michael Sullivan, Summer Intern

For additional  copies of this report, please  contact the Boston regional oflice by telephone at 
(617) 565-1050,  or by fa  at (617) 565-3751.  EXECUTIVE  SUMMARY 
PURPOSE 
To update  an assessment  of the usefi-dness and impact of information  in the National 
Practitioner  Data Bank to hospitals. 
BACKGROUND 
Since September  1, 1990, the National Practitioner  Data Bank (hereafter  referred  to as the

Data Bank) has received  and maintained  records  of malpractice  payments  and adverse

actions against licensed health care practitioners.  It provides  hospitals  and other health

care entities  with information  relating  to the professional  competence  and conduct  of

health  care practitioners.  Hospitals  are required  to request  information  from the Data

Bank about every physician  and dentist who applies for appointment.  In addition,  hospitals

must query at least once every 2 years on every practitioner  who is on their medical  staff

or who has privileges.  They may query about any practitioner  seeking or holding

privileges  at any time.  As of February  25,  1994, hospitals had received,  in response  to

queries,  108,552 reports  of malpractice  payments  or adverse actions against physicians,

dentists,  and other health care practitioners.

In February  1993, we released  a report  that evaluated  the usefulness  and impact  of reports

to hospitals  through  March  1992.  In December  1993, the Administrator  of the Health

Resources  and Services Administration  (HRSA) asked us to update the information  in the

February  1992 report using more recent data.  We agreed to conduct  the study.  Our

February  1993 report  found that a majority  of Data Bank reports  were useful to hospitals

as reflected  by a number  of measures  of usefulness.  However,  it was very rare  for Data

Bank reports  to lead hospitals to make privileging  decisions they would not have made

without the reports.

The data in this report  result  from a survey we conducted  of hospitals  that received

reports  of malpractice  payments  or adverse actions from the Data Bank.  We sampled

400 matches--instances  when a querying  hospital received  a report  of a specific  incident-

from the universe  of 89,430 hospital matches from March  20,  1992 through

February  25,  1994.  We asked hospital officials questions about how they used and what

their assessments  were of the reports;  we received  257 useable  responses.  Throughout  the

report  we compare  the results of our original  study, which covered  the period  from

September  1, 1990 through March  19, 1992 (period A), to the results  of this survey,

which covered  the period  from March  20,  1992 through February  25,  1994 (period B).

Appendix  A gives details of our methodology.

i  FINDINGS 
USEFULNESS  TO HOSPITMS:  Hospital  officials found  a much higher propotion  of 
reports to be useful; however,  a much smaller propotion  of reports provided 
inforndon  that was previously  unknown to hospital staff. 
(cid:1) The proportion  of reports  that hospital officials consider  useful increased  from 
58 percent  in the period from September  1, 1990 to March  19, 1992 (period A) to 
83 percent  in the period  from March  20,  1992 to February  25,  1994 (period  B). 
(cid:1) Response  time,  which had been very problematic  in the early part of period  A, 
improved  significantly  toward the end of period  A; that improvement  was 
maintained  throughout  period  B.  The Data Banks electronic  querying  process, 
which was begun in period B, allowed hospitals to receive  reports  much more 
quickly  than if they submitted  queries by mail. 
(cid:1) The proportion  of reports  that provided  information  previously  unknown  to hospital 
staffs declined  from 40 percent  in period  A to 28 percent  in period B. 
(cid:1) In neither  period  did hospital officials see accuracy  of reporting  to be a large 
problem. 
(cid:1) The reasons  hospital officials found reports  useful or not useful remained  largely 
unchanged.  The most commonly  cited reason in both periods  for the reports  being 
useful  was that they coni%rned information  from other sources;  the most commonly 
cited reason  in both periods  for the reports  not being useful was that they 
duplicated  information  available  elsewhere. 
(cid:1) (Measured  only in period  B.)  Seventy-seven  percent  of our respondents  felt that 
responses  from the Data Bank that listed no adverse information  were at least 
somewhat useful to them.  Seventy-one percent  found it worthwhile  to query the 
Data Bank about all practitioners,  as the current  law requires. 
IMPACT  ON DECISIONS:  In both periods,  hospitals seldom made different privileging 
decisions  than they would have made without the Data Bank reports. 
(cid:1) In period  A, according  to hospital officials,  if hospitals had not received  the Data 
Bank reports,  their privileging  decisions would have been different  1 percent  of the 
time;  in period B, thk  figure was 2 percent. 
(cid:1) In period  A,  80 percent  of reports had little chance to have an impact on hospitals 
privileging  decisions;  in period B, this figure dropped to 75 percent.  These reports 
arrived  after the decision was made,  duplicated  available  information,  or the 
practitioner  did not go through the privilege  decision process. 
ii  (cid:1) Thepercent  ofrepofis  that could have hadtipact  onhospitils'  privileging 
decisions  butdidnot  increased  from  19percent  (23 reports)  inperiod  A to 
24 percent  (56reports)  inperiod  B.  These arereports  that hospitals  received 
before  they made their privileging  decisions and that provided  them with new 
information  on a practitioner. 
CONCLUSION 
The information  in this report  contributes  to an understanding  of the usefidness  and impact 
of the Data Bank in hospitals.  It reveals that the Data Bank is operating  much more 
smoothly  than during its early  implementation  period.  Hospital  officials  are receiving 
reports  in a much more timely fashion and they are now much more  likely to characterize 
Data Bank information  as useful.  At the same time,  our data reveal  that Data Bank 
reports  seldom affect privileging  decisions  of hospitals. 
During  this and prior  inspections  on the Data Bank, we have become  ever more  aware  of 
differing  expectations  of the Data Bank.  Thus,  any assessments  of the Data Banks 
usefulness  and impact will depend heavily on how these expectations  are expressed  and on 
the relative  emphasis  given to them.  In that context,  we offer the following  concluding 
observations  concerning  three  important  expectations  about the Data Bank. 
(cid:1) Data Bank as a Reliable,  Centralized  Source of Information.  In the sense that 
the Data Bank is expected to serve as such a source of information  about adverse 
actions and medical  malpractice  payments,  it seems to be working  quite well.  It is 
a timely,  accurate  source that is widely regarded  as useful--mainly  because  it 
confirms  information  available  from other (presumably  less reliable)  sources. 
(cid:1) Data Bank as a Unique Source of Information.  In the sense that the Data Bank is 
expected  to serve as a unique  source of information--that  is, one unavailable 
elsewhere--it  clearly  has some value.  In our sample,  28 percent  of the reports 
provided  new information  to the hospitals.  That 28 percent  projects  to 
25,040  reports  providing  new information  to hospitals over a period  of almost 
2 years. 
(cid:1) Data Bank as a Mechanism  to Protect the Public by Preventing  Incompetent 
and/or  Unprofessional  Practitioners from  Practicing  in Hospitals.  Clearly,  this is 
the most ambitious  and controversial  of these expectations.  It is also the one most 
difficult  to assess without more information.  In one sense, the fact that 2 percent 
of reports  are having an impact on privileging  decisions  may seem inappropriately 
low.  It may suggest that hospitals are overly reluctant  to take adverse  actions 
against  incompetent  and/or  unprofessional  practitioners. 
Yet,  to the extent that only a small percent  of practitioners  are unfit to practice, 
one may argue that nothing is necessarily  inappropriate  about 2 percent  of reports, 
which projects  to 1,520 reports  over a period  of almost 2 years,  having an impact 
on privileging  decisions.  These  1,520 reports  involve hundreds  of practitioners 
111
 and affect thousands  of patients they serve.  Finally,  it is important  to recognize 
that the very existence  of the Data Bank may deter  some unfit practitioners  from 
even applying to hospitals  for practice  privileges  and may encourage  other 
practitioners  to be more forthcoming  in the applications  they submit for hospital 
privileges. 
COMMENTS  ON THE DRAITIREPORT 
We solicited  and received  comments  on the draft report  from the Public Health  Service 
(PHS),  the Assistant  Secretary  for Planning  and Evaluation  (ASPE),  the American 
Hospital  Association  (AHA),  and the American  Medical Association  (AMA).  Their 
comments  appear  in fill  in appendix C.  Below we summarize  their comments,  and,  in 
italics,  our responses. 
PHS Comments 
The PHS expressed  appreciation  for our inquiry and indicated  that the report  would be 
helpful.  It called for one minor change in the background  section of the report  where we 
explain the Data Bank law.  We appreciate  the positive  response  f?om  PHS.  We made  the 
change  requested. 
ASPE Comments 
The ASPE supported  the purpose  of our inquiry  and noted that the methodology  seemed to

be  appropriate.  It added,  however,  that the conclusion  that the Data Bank is useful  is

questionable  and that the data in the report  might be used to support  a contrary

conclusion.  We did  not  conclude  that  the Data  Bank  is usefil.  We elaborated  on how

ones assessments  of usefulness and impact will depend heavily on ones expectations  of

the Data Bank.

AHA Comments 
The AHA found it encouraging  that hospital respondents  regarded  Data Bank reports  to 
be more usefid  and timely than during our prior  survey period.  At the same time,  it 
expressed  concern  that the supplemental  role of the Data Bank in hospital credentialing 
and privileging  efforts may come at too high a price.   How one assesses the 
pefonnance  of the Data Bank,  as we noted above,  is likely to depend heavily  on ones 
expectations  of it in the first place.  Our intention,  in focusing  on the usefulness  and 
impact of Data Bank  reports,  was to contribute  to such assessments  whatever  ones 
starting place. 
AMA Comments 
The AMA expressed  considerable  concern  about the cost-effectiveness  of the Data Bank 
and about our report.  As with our prior  report,  it found this one misleading  in that it 
focused on the universe  of matches rather  than the much larger universe  of queries  to the 
iv  Data Bank.  It also found misleading  our findings that (1) 77 percent  of the hospital 
respondents  found Data Bank responses  with no adverse  information  about a practitioner 
to be at least somewhat useful and (2) 71 percent  found it worthwhile  to query the Data 
Bank for all practitioners,  as the law requires.  It specified that the Likert  scale we used 
for the former  finding and the yes-no format for the latter accounted  for what  may have 
been predictable  responses.  Finally,  it commented  that we gave insufficient  attention  to 
our draft report  finding that 5 percent  of hospital respondents  found the Data Bank match 
reports  sent them to be incomplete. 
We disagree  with the Ah4A on the value of focusing  on matches.  In our prior  report and 
in this one,  we focused  on matches to provide  discrete, practical feedback  on the 
information  actually provided  to hospitals by the Data Bank.  With respect to the above-
noted findings,  we note that the 77percent  of respondents  who regarded the Data Bank 
responses with no adverse  information  to be at least  somewhat useful included 
26 percent  who regarded it as  extremely or very usejl.d and 27percent  as  moderately 
usefil.   The use of a yes-no format  to record an overall assessment  of the Data Bank  is, 
we believe,  an unbiased approach  toward obtaining a basically positive  or negative 
reaction.  Finally,  we agreed with the AMA  that if 5 percent  of Data Bank repotis  were 
incomplete  that would be significant  information  warranting  immediate  attention. 
Accordingly,  we conducted  a follow-up  inquiry,  and, as we note on page  7, found  that all 
of the reports initially  cited as incomplete were explainable  as timing issues or as 
respondent  errors.  None  involved actual nonrepotiing  to the Data Bank. 
v  TABLE  OF  CONTENTS 
PAGE 
EXECUTIVE  SUMMARY

INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .1

FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .3

 Usefulness  to Hospitals..  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .3


10

Impact onDecisiom  ........... ....... ............ . . . . . . . . 
CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  13

COMMENTS  ON THE DRAFI REPORT  . . . . . . . . . . . . . . . . . . . .  . . . . .  14

APPENDICES

A:  Methodology  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . .  A-1

B:  Summary  of Hospitals  Responses to OIG Mail Survey  . . . . . . . . . . . . . . . . . B-1

c:  Complete Comments ontheDraft  Report.  . . . . .  . . . . . . . . . . . . . . . . . . .c-1

D:  Notes  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D-1
 INTRODUCTION 
PURPOSE 
To update  an assessment  of the usefulness  and impact of information  in the National 
Practitioner  Data Bank to hospitals. 
BACKGROUND 
Since September  1, 1990, the National  Practitioner  Data Bank has received  and 
maintained  records  of malpractice  payments  and adverse actions taken by hospitals,  other 
health  care entities,  licensing boards,  and professional  societies against licensed health 
care practitioners.  It provides  hospitals and other health care entities with information 
relating  to the professional  competence  and conduct of physicians,  dentists,  and other 
health care practitioners.  The Data Bank was established  by Title IV of the Health  Care 
Quality Improvement  Act of 1986 (P.L.  99-660),  as amended,  and is fi.mded by user  fees. 
It is operated  by the Unisys Corporation  under contract to the Health Resources  and 
Services  Administration  (HRSA) of the Public Health Service (PHS). 
Hospitals  are required  to request  information  from the Data Bank about every physician 
and dentist  who applies for appointment.  Hospitals must query about all medical  and 
dental  staff and other health care practitioners  with clinical privileges  at least once every 
2 years.  They have the option of querying  about any practitioner  with privileges  (or who 
is seeking privileges)  at any time.  The Data Bank is intended to provide  information  to 
hospitals  to help them make decisions about hiring,  granting privileges  to, and disciplining 
practitioners. 
As of February  25,  1994, hospitals had received,  in response to queries,  108,552 matched 
reports  of malpractice  payments  or adverse actions against physicians,  dentists,  and other 
health care practitioners.  We summarized  in detail the profiles  of these  matches  in a 
report  released  in August  1994.1 
In February  1993, we released  a report  that evaluated  the usefulness  and impact of reports 
to hospitals  through  March  1992.2  That report provided  officials in the Department  and 
parties  interested  in the Data Bank with an early evaluation  of the Data Banks 
effectiveness  and utility.  In December  1993, the Administrator  of HRSA asked us to 
update  the information  in the February  1993 report using more recent  matches.  He 
cited significant  changes  in the operation  of the Data Bank,  a more  sizable universe  from 
which to draw experiences,  and the usefulness  of the report to officials  in HRSA as 
reasons  for his request.  We agreed to conduct the study.  In addition to this report,  we 
are issuing a similar report  summarizing  the experiences  of health maintenance 
organizations,  preferred  provider  organizations,  and group practices  using Data Bank 
information. 
1
 SUMMARY  OF FEBRUARY  1993 REPORT 
Our February  1993 report  found that a majority  of Data Bank reports  were useful to 
hospitals using a number  of measures  of usefulness.  However,  it was very rare  for Data 
Bank reports  to lead hospitals to make privileging  decisions they would not have made 
without the reports.  Because usefulness  of the reports  was sharply affected by the 
timeliness  of reporting,  we recommended  that PHS take steps to improve  and report  upon 
timeliness.  We also recommended  that the Joint Commission  on Accreditation  of 
Healthcare  Organizations  establish  guidelines  on how quickly hospitals  should query after 
receiving  privilege  applications.  We received  generally  positive comments  on a draft  of 
the report.  The most significant  objections to it came from the Assistant  Secretary  for 
Planning  and Evaluation  in the U.S.  Department  of Health  and Human  Services  and the 
American  Medical  Association  (AMA), both of whom objected to our allowing users  to 
develop  their  own definitions  of usefulness.  The AMA also sharply disagreed  with our 
methodology  of looking solely at matches and not looking at reports  that listed no 
information  on file. 
METHODOLOGY 
The data presented  in this report  are derived from a survey of hospitals  that received 
reports  of malpractice  payments  or adverse actions from the Data Bank.  Our 
methodology  was intended to allow us to compare  that data to the results  of the study 
published  in February  1993; therefore,  the survey questions,  whenever  possible,  were 
asked in an identical  manner.  We did, however,  attempt to address some of the concerns 
raised by our earlier  report.  Notably,  we probed more about why reports  did not have 
impact and asked about the usefi.dness of receiving  verification  that no information  is in 
the Data Bank.  We sampled 400 matches--instances  when a querying  hospital  received  a 
report  of a specific incident--from  the universe  of 89,430 hospital matches  from 
March  20,  1992 through  February  25,  1994.  We received  257 useable  responses.  Our 
findings can be projected  to this universe  of matches.  Appendix  A gives details of our 
methodology  and provides  information  about the reports,  practitioners,  and hospitals 
included  in the study. 
We conducted  this study in accordance  with the Quali~  Standards for  Inspections  issued 
by the Presidents  Council  on Integrity  and Efficiency. 
2
 FINDINGS 
USEFULNESS  TO HOSPITWS:  Hospital  officials found  a much higher proportion  of 
reports to be useful; however,  a much smaller propo~on of reports provided 
info--on  that was previously  unknown to hospital staff. 
Whether  a report  from the Data Bank is useful to a hospital depends on several  factors. 
Some factors  can be determined  objectively,  such as whether the report  provides  new 
information  or duplicates  other reports,  whether  it is accurate,  and whether  the report 
arrives  at the hospital  in time to be used in the privileging  process.  Other factors  are 
more  subjective,  such as whether the report  is relevant  to the reported  practitioners 
competency  and professionalism.  Measured  by both objective  and subjective  criteria,  the 
Data Bank appears to be continuing  to provide useful information  to hospitals  (see 
figure  1). 
	 The proportion  of reports  that hospital officials consider useful  increased  from 
58 percent  in the period  from September  1, 1990 to March  19, 1992 (period  A) to 
83 percent  in the period from March 20,  1992 to February  25,  1994 (period B). 
In period  A, there  were no statistically  significant differences  in the percentages  of reports

judged  useful because  of type of incident involved (malpractice  payment  vs. adverse

action),  amount  of malpractice  payment,  location of report  (in-State vs. out-of-State),  or

type of adverse  action.  In period B, however,  adverse actions were  significantly  less

likely to be rated useful than malpractice  payments.  All the other comparisons  showed no

differences  (see table  1).

It is difficult  to explain why adverse actions would be less likely to be rated useful,

especially  since one might expect the opposite to be true.  Indeed,  when we asked hospital

officials  about how they would rate,  in general,  hospital privileges  action reports,

licensing board  action reports,  and malpractice  payment  reports,  70 percent  rated  licensing

board  actions (in theory  or in practice)  extremely  useful,  68 percent  rated  hospital

privileging  actions extremely  useful,  and only 40 percent  rated malpractice  payments

extremely  useful.3  The difference  in the proportions  is not affected by other available

information  or by timeliness.  There  is no difference  in the proportion  of malpractice

reports  and adverse  action reports  that provided  information  unavailable  elsewhere.

Likewise,  timeliness  is not different  for the two types of reports.

	 Response time,  which had been very problematic  in the early part of period  A, 
improved  significantly  toward the end of period  A; that improvement  was 
maintained  throughout  period  B.  The Data Banks electronic  querying  process, 
which was begun in period  B, allowed hospitals to receive  reports  much more 
quickly  than if they submitted queries by mail. 
3
 Figure  1 
USEFULNESS  OF DATA BANK REPORTS: 
Percent 
Change From ParbcJA (9/1/90-3/31/92) To Period B (WWfZ-2/25/W 
95-
9c-
85- Propo#on  &nsldemd  Useful 
8t-
75-
70-
8t -
80-
55-
50-
ProtMion  Priwidng  Mnmdon 
45-
Unavallabie Elsewbm 
4c-
35-
3t-
25-
.20-J
A B  A B 
Soumew Office of Inspector General Surveys of Hospital CMdals. 
Note  Perfod k  N-142 Responses, Period B N-257 Responsea. 
This improvement  in response  time helps account for the significant  increase  in the 
proportion  of reports  considered  to be usefi.d.  In period A, officials often reported  that 
reports  were not usefid because of their lack of timeliness. 
In period  A, we found that response time had been steadily improving  over the study 
period.  The median  response time dropped from  123 days to 26 days over the  18 month 
period  (measured  each quarter).  That decline in response time has not continued  through 
period  B.  The median  response time was 23 days over period B and has ranged  from 
35 days to 14 days,  with no particular  trend over time.  Still the overall  improvement  in 
response  time was dramatic  (over the entire period A median  response  time was 44 days). 
Early  in period  B, HRSA made software  available to hospitals that allowed them to query 
electronically.  By the end of the Data Banks third year,  47 percent  of all queries  were 
being  submitted  electronically .4 In period  B, 26 percent  of respondents  used electronic 
submission.  Respondents  who queried electronically  received  responses  much  faster than 
those who did not (median is 17 days vs. 27 days).  Interestingly,  they were not more 
likely to find the reports  useful (82 percent  of those who queried electronically  found the 
reports  usefi,d while 84 percent  of those who did not query electronically  found them 
useful). 
4
 TABLE  1 
USEFULmS  To  HOSPITW  OF  DIFFEREN  TYPES 
OF  DATA  BANK  REPORTS 
REPORTCS ONSIDEREUDS EFUL
TYPE  OFREPORT 
period B 
period A 
IncidentInvolved 
85%(N=219) * 
59%(N=74) 
MalpracticePayment 
67%(N=24) * 
57%(N=9) 
AdverseAction 
Amountof MalpracticePayment 
90%(N=72) 
57%(N=16) 
Less Than $30,000 
83%(N=147) 
61%(N=25) 
$30,000 or More 
Type of Adverse Action 
75%(N=16) 
53%(N=20) 
BoardLlcensureAction 
50%(N=8) 
64%(N=21) 
HospitalPrivilegesAction 
Locationof Repofi 
85%(N=97) 
81%(N=72) 
Out-of-State 
83%(N=146) 
56%(N=11) 
In-State 
*Differences are signi#icmt at the 95 percent confidence level. 
Sources: @ice  of Inspector General Surveys of Hospital ojiciak. 
In period  A, the proportion  of reports  arriving before hospitals made final decisions  on the 
practitioners  involved ranged  from 44 percent  in the first quarter  of the period  to 
66 percent  in the last.  In period B, the proportion  of reports  arriving  prior  to the final 
Better respome  time accounts  for 
decision  increased  to 83 percent  over the entire period. 
some of this improvement,  but hospital officials were partly  responsible  for the low 
In period  A,  18 percent  of all reports  did not arrive  on 
proportion  of on-time  arrivals. 
time because  the hospital  submitted  a query after having made a privileging  decision.  In 
period  B, 6 percent  did not submit their Data Bank request until after the decision; 
primarily  because  they felt they already had sufficient information  to make the decision. 
	 The proportion  of reports  that provided  information  previously  unknown  to hospital 
staffs declined  from 40 percent  in period  A to 28 percent  in period B. 
Practitioners  themselves  and malpractice  insurers  were more likely to be sources of 
information  about incidents  in the Data Bank reports  in period B than they were in period 
A (see table 2).  It is possible that the increase  in the proportion  of reports  that gave 
hospitals  information  on the practitioners  named in the reports provided  was in part caused 
The existence  of the Data Bank and practitioners 
by the maturation  of the Data Bank. 
knowledge  of the Data Bank being a source of information  for hospitals may make 
practitioners  more likely to disclose malpractice  payment  and adverse  action information. 
awareness  of the Data Bank and of hospitals use of the Data 
It is likely that practitioners 
5  Increased  awareness  of the Data Bank might 
Bank have grown since the end of Period  A. 
well be deterring  practitioners  from withholding  information. 
In period  A, we cited problems  with hospitals not receiving  important  information  from 
their  own States licensing board  and from other hospitals  in their  State; these problems 
In period  A, 20 percent  of reports  originally  submitted by 
appear to be continuing. 
licensing boards  in the hospitils  own States were the hospitals  only source of ~owledge 
about the incident  and 10 percent  of the time hospitals  only learned  of board  actlom  from 
In period B, 8 percent  of reports  originally  submitted by 
sources other than the boards. 
own States were the only source of knowledge  about the 
licensing boards  in the hospitals 
incident  in the hospitals  and 33 percent  of the time hospitals  only learned  of board  actions 
In both periods  A and B, 50 percent  of Data Ba& 
from sources  other than the boards. 
re~orts  on clinical privilege  actions taken by other hospitals provided  information
. 
otherwise  unavailable. 
TABLE  2 
SOURCES  OF  DATA  BANK  INFORMATION 
PERCENOT FREPORTHS OSPITAOLFFICIALS 
WEREAWAREOFFROMEACHSOURCE 
PERIOD B: 
PERIOD A: 
SOURCE  (3/19/92-2/25/94) 
(9/1/90-3/18/92) 
(N=247) 
(N= 142) 
60% 
53% 
Practitioner 
7% 
9% 
StateLicensingBoardIn-State 
1% 
<1% 
StateLicensingBoardOut-of-State 
14% 
9% 
MalpracticeInsurer In-State 
2% 
o% 
MalpracticeInsurer Out-of-State 
5% 
4% 
HospitalIn-State 
2% 
2% 
HospitalOut-of-State 
1% 
<1% 
ProfessionalSocietyIn-State 
<1% 
o% 
ProfessionalSocietyOut-of-State 
7% 
7% 
Other In-State 
1% 
o% 
Other Out-of-State 
Note: Propo~ions will not add to 100% because hospitals could have more than one source of inforwtion. 
Sources: Ofjice of Inspector General Surveys of Hospital @icials. 
The surprising  finding from Period  A that hospitals  seemed more likely to be aware of 
malpractice  payments  and adverse actions occurring  in other States than of payments  and 
In period  A, hospitals  were  aware  of 
actions in their  own States was not true in Period B. 
6  information  contained  in 85 percent  of reports  from other States, but in only 55 percent  of 
reports  from their own States.  In period B, hospitals were aware of information  contained 
in 70 percent  of reports  from other States and 72 percent  of reports  from their own States. 
	 In neither period  did hospital officials see accuracy  of reporting  to be a large 
problem. 
For period  A, we found that no hospital  in our sample responded  that the Data Bank 
report  it received  was inaccurate.  In period B, no hospital determined,  after making 
additional  inquiries,  that the information  in the Data Bank report  was inaccurate. 
In our draft report,  we had indicated that there was growing evidence that the Data Bank 
is not reporting  to hospitals  all the information  it should.  We based that on the finding 
that in period  B 12 hospitals  (almost 5 percent  of all respondents)  indicated that the 
responses  received  from the Data Bank were incomplete  (i.e.,  that the Data Bank should 
have had additional  information  on the practitioner  in question).  In period  A, by contrast, 
only one hospital  said that the Data Bank response was incomplete. 
Upon further  inquiry  since the issuance of our draft report,  we determined  that none of 
the Data Bank reports  cited by the 12 hospitals  as being incomplete  during period  B 
remain  incomplete  today.  Moreover,  we found that all of the Data Bank reports  identified 
by the hospitals  as incomplete  could be explained  as errors  by the hospital  respondents  or 
as timing  issues (wherein  a hospital learned  of a malpractice  payment  or disciplinary 
actions from another  source before  it was sent to the Data Bank).  We found no instances 
of nonreporting  to the Data Bank. 
	 The reasons hospital  officials found reports useful or not usefi.d remained  largely 
unchanged.  In both periods,  the most commonly  cited reason for the reports  being 
useful was that they confirmed  information  from other sources;  the most commonly 
cited reason  in both periods  for the reports  not being useful was that they 
duplicated  information  available  elsewhere. 
Table 3 demonstrates  the differences  between period A and period B in the reasons 
hospitals  considered  reports useful and not useful.  It is clear that hospitals  find the 
reports  useful  in large part because they confirm  information  available  elsewhere.  It is 
likely that if they found the other sources very reliable  and trustworthy,  they would not 
find the Data Bank information  useft.d because  it was duplicative.5  The fact that many 
find the reports  useful because they are confirmatory  may indicate that the Data Bank is 
filling a need for a reliable  source of information.  In fact, of the reports  that told 
hospitals  about incidents they were aware of from other sources,  15 percent  were 
inconsistent  with those other sources.  Yet,  as we already noted,  no Data Bank report  was 
found to be inaccurate  upon further  inquiry.  The Data Bank, while it may provide 
information  available  elsewhere,  is a consistently  accurate  source of information.  This 
gives us key insights into how hospitals rely upon the Data Bank and why reports  are 
useful to so many hospitals. 
7
 	 (Measured  only in period B.)  Seventy-seven percent  of our respondents  felt that 
responses  from the Data Bank that listed no adverse  information  were at least 
somewhat useful to them.  Seventy-one percent  found it worthwhile  to query the 
Data Bank about all practitioners,  as the current  law requires. 
In period  B, we asked two questions we did not ask in period A that help assess the 
usefulness  of the Data Bank.  The first asked  How useful to you are responses  from the 
Data Bank that do not list any adverse  information?  (Choices were  extremely useful,  
very useful,  moderately  useful,  somewhat usefi.d, or  not useful.)  Among the 
77 percent  who answered  that the reports  were useful,  the great majority  designated  the 
moderately  or  somewhat useful categories. 
The second question  we asked was All things considered,  do you feel it is worthwhile  to 
query the Data Bank about all practitioners  in your hospital as current  law requires? 
About 71 percent  of respondents  said yes.  Officials felt the information  was worthwhile 
for all types of queries:  that it was confhnatory,  that it was a reliable  source of 
information,  that it was a source of information  when practitioners  failed to notify the 
hospital  of incidents,  and that it was national  in scope.  Officials who felt it was not 
worthwhile  to query frequently  felt that the expense of time and money was not worth  it, 
that they can use other sources easily to get the same information,  and that there  is 
incomplete  or insufficient  information  in the Data Bank. 
8
 TABLE  3 
REASONS  OFFICIALS  CONSIDERED  REPORTS  USEFUL  AND NOT  USEFUL 
PROPORTIOONF REPORTTS HATHOSPITAL
OFFICIALCSO  NSIDEREUDS EFUL
Period A:  Period B: 
R1 EASONC ONSIDEREUDS EFUL (9/1/90-3/18/92)  (3/20/92-2/25194) 
Number of reports  Number of reports 
considered  considered 
useful=83  usefil =203 
Confirmed Other Available Information  60%  65% 
Helped Judge PractitionersCompetency  37%  32% 
Provided Information UnavailableElsewhere  30%  24% 
Helped Judge Practitioners Professionalism  22%  25% 
Other Reason  10%  6% 
PROPORTIOONF REPORTTS HATHOSPITAL
OFFICIALDSI DNOTCONSIDEURS  EFUL
Period A:  Period B: 
REASONN OTCONSIDEREUDS EFUL (9/1/90-3/18/92)  (3/20192-2/25/94) 
Number of reports  Number of reports 
not considered  not considered 
usejid=55  use@l=40 
InformationAvailable Elsewhere  52%  75% 
Information Did Not Help Judge Competencyor  63%  45% 
Professionalism 
Report Not Timely  54%  18% 
Report Inaccurate  <1%  5% 
Other Reason  19%  15% 
Note: In period A, 58 percent of reports were found usefid and in period B, 83 percent were found usejid. 
Proportions in this table will not add to 100% because hospitals could have more than one reason. 
Sources: (@e  of Inspector General Surveys of Hospital 0j7cials. 
9
 IMPACT  ON DECISIONS:  In both periods,  hospitals seldom made different privileging 
decisions  than they would have made without the Data Bank reports. 
The impact that receiving  information  from the Data Bank has on hospitals  can be 
characterized  in several ways.  Impact may include giving hospital  administrators 
confidence  that they have complete  information  about their medical  staffs.  It may include 
adding information  to practitioners  files that could be used in the future should questions 
arise.  But Data Bank reports  can have their most direct  impact by affecting the outcome 
of decisions  on practitioners  who have just applied for new or continued  hospital 
privileges.  For this reason,  we asked hospitals  (in both periods  A and B) the following 
question:  Would your decision regarding  the practitioner  have been different  if you had 
not received  the Data Bank report?  Because our measurement  of impact focused on the 
privileges  decisions,  we did not include in this analysis any situations when decisions  were 
still pending.  In period  A,  16 percent  of Data Bank reports  involved practitioners  for 
whom the hospitals  privileging  decisions were still pending at the time of our survey;  in 
period  B, this figure was 8 percent. 
Figure  2 demonstrates  how the proportions  of reports  that had impact,  no potential  for 
impact,  and potential  for impact changed over the two periods. 
In period  A, according  to hospital  officials,  if hospitals had not received  the Data 
Ba&  reports,  their privileging  decisions  would have been different  1 percent  of the 
time;  in period  B, this figure was 2 percent. 
In period  B, of the 236 officials who answered the question,  4 said their decisions  would 
have been different.  One hospital terminated  privileges  immediately  upon receiving  the 
Data Bank report  (which reported  a voluntary  surrender  of privileges  while under,  or to 
avoid,  investigation  for incompetence,  malpractice,  or negligence).  Another  hospital 
reported  that the practitioner  withdrew  his application,  but it would have denied privileges 
based on the report  (which reported  conditional  reinstatement  of privileges  at another 
hospital).  A third hospital made a decision to grant temporary  privileges  prior  to 
receiving  the Data Bank response,  but would not have granted them had it known the 
information  in the response  (which described  a $50,000  surgery-related  malpractice 
payment).  A fourth hospital temporarily  suspended and investigated  a physician  based on 
the Data Bank report  (which detailed  a $95,000  anesthesia-related  malpractice  payment); 
the hospital  eventually  granted privileges  to the physician. 
In period  B, we asked a follow-up question about whether the report,  if it did not cause 
the officials  to make a different  decision,  made the officials feel more confident,  less 
confident,  or no different.  Of the  188 respondents,  only 7 felt the report  made them less 
confident  and 49 (26 percent)  felt the reports  made them more confident  about their 
decisions.  In all but two of these cases,  the practitioner  involved was granted  full 
privileges.  This is, therefore,  an unexpected  result.  One would expect that receiving 
adverse  information  would make decision makers  less confident  about granting  privileges. 
10
 (cid:1) In period  A, 80percent  ofrepotis  hadlitile  chance tohavean  impact onhospi~ls' 
privileging  decisions;  inperiod  B,thisfigure  dropped to75  percent.  These reports 
arrived  after the decision was made,  duplicated  available  information,  or the 
practitioner  did not go through the privilege  decision process. 
In period  A, that 80 percent  (97 reports)  consisted of 
10 reports  that named practitioners  who did not go through  the privilege  decision 
process.  These practitioners  either withdrew their applications  or requested  only 
temporary  privileges. 
46 reports  that were not received  prior  to hospitals making  decisions.  For 
22 reports,  the hospitals  did not query the Data Bank until after the decisions  and 
for 24 reports,  they queried  in advance of the decisions. 
41 reports  that,  though received  by hospitals before  credentialing  decisions  were 
made,  provided  only information  already known to the hospitals. 
In period  B, the 75 percent  (176 reports)  consisted  of 
16 reports  that named practitioners  who did not go through  the privilege  decision 
process. 
27 reports  that were not received  prior  to hospitals making decisions. 
133 reports  that,  though received  by hospitals before  decisions  were made, 
provided  only information  already known to the hospitals. 
In period  B, we also asked officials why the reports did not lead them to make privileging 
decisions  they would not have made without the reports.  Of responding  officials, 
55 percent  said at least part of the reason the reports  did not have impact was that the 
reports  did not indicate a problem  warranting  restricting  or denying privileges;  54 percent 
cited already  knowing about the information  as a reason;  8 percent  cited not receiving  the 
report  in time to affect the decision,  and 3 percent  said they would have restricted  or 
denied privileges  anyway. 
  The percent  of reports  that could have had impact on hospitals privileging 
decisions  but did not increased  from  19 percent  (23 reports)  in period  A to 
24 percent  (56 reports)  in period B.  These are reports  that hospitals  received 
before  they made their privileging  decisions  and that provided  them with new 
information  on a practitioner. 
In period  A, we did not ask officials who responded  that the reports  did not alter their 
credentialing  decisions  why they did not.  However,  we analyzed whether  or not they 
found the reports  useful and why.  In period A, about half of the reports  that arrived 
before hospitals  decisions were finalized  and contained  information  that neither  the 
11  Figure 2 
IMPACT OF DATA BANK REPORTS: 
CHANGE FROM PERIOD A TO PERIOD B 
E 
o  T 
PERIOD A  PERIOD B 
(n-142)  (n-257) 
Data  Perbd A-9/l19CW8/92,  Perfod 6-3/19/92-2/25/94.

Sources  OffIce of Inspector Wmral  Sutveys of Hospti  CMcials.

Now  Period B proportions add up tomore then 100% due to rounding.

practitioner  nor any other sources had provided  were judged  not useful.  Most often these 
reports  were considered  not useful because they could not help judge  competency  or 
professionalism.  The other half were considered  useful.  In period  B, only  11 percent  of 
the reports  that arrived  before hospitals decisions were finalized  and contained 
information  that neither  the practitioner  nor any other sources had provided  were judged 
not useful.  The primary  reason these reports  were judged  not useful was again because 
they did not help judge  the practitioners  competency  or professionalism. 
ln  period  B, we asked officials who said that their privileging  decisions  would not have 
been different  without the Data Bank report  why their decisions  would not have been 
different.  Of the reports  that arrived prior  to the final decisions  and that contained 
information  not available  from other sources,  officials said 64 percent  did not indicate  a 
problem  that warranted  restricting  or denying privileges.  No other reason had a frequency 
of more  than 4 (7 percent). b  One official said that the hospital restricted  or denied 
privileges  anyway. 
12
 CONCLUSION 
The information  in this report  contributes  to an understanding  of the usefulness  and impact 
of the Data Bank in hospitals.  It reveals  that the Data Bank is operating  much more 
smoothly  than during  its early implementation  period.  Hospital officials are receiving 
reports  in a much more timely fashion and they are now much more likely to characterize 
Data Bank information  as useful.  At the same time,  our data reveal  that Data Bank 
reports  seldom affect privileging  decisions  of hospitals. 
During  this and prior  inspections  on the Data Bank, we have become  ever more  aware  of 
differing  expectations  of the Data Bank.  Thus,  any assessments  of the Data Banks 
usefulness  and impact will depend heavily on how these expectations  are expressed  and on 
the relative  emphasis  given to them.  In that context,  we offer the following  concluding 
observations  concerning  three  important  expectations  about the Data Bank. 
	 Data Bank as a Reliable,  Centralized  Source of Information.  In the sense that 
the Data Bank is expected to serve as such a source of information  about adverse 
actions and medical  malpractice  payments,  it seems to be working  quite well.  It is 
a timely,  accurate  source that is widely regarded  as useftd--mainly  because  it 
confh-ms information  available  from other (presumably  less reliable)  sources. 
	 Data Bank as a Unique Source of Information.  In the sense that the Dab  Bank is 
expected  to serve as a unique  source of information--that  is, one unavailable 
elsewhere--it  clearly  has some value.  In our sample,  28 percent  of the reports 
provided  new information  to the hospitals.  That 28 percent  projects  to 
25,040  reports  providing  new information  to hospitals over a period  of almost 
2 years7. 
	 Data Bank as a Mechanism  to Protect  the Public by Preventing  Incompetent 
andlor  Unprofessional Practitioners from  Practicing  in Hospitals.  Clearly,  this is 
the most ambitious  and controversial  of these expectations.  It is also the one most 
difficult  to assess without more information.  In one sense, the fact that 2 percent 
of reports  are having an impact on privileging  decisions may seem inappropriately 
low.  It may suggest that hospitals are overly reluctant  to take adverse  actions 
against incompetent  and/or unprofessional  practitioners. 
Yet,  to the extent that only a small percent  of practitioners  are unfit to practice, 
one may argue that nothing is necessarily  inappropriate  about 2 percent  of reports, 
which projects  to 1,520 reports  over a period  of almost 2 years8, having  an impact 
on privileging  decisions.  These  1,520 reports  involve hundreds  of practitioners 
and affect thousands of patients served by these practitioners.  Finally,  it is 
important  to recognize  that the very existence  of the Data Bank may deter  some 
unfit practitioners  from even applying to hospitals for practice  privileges  and may 
encourage  other practitioners  to be more forthcoming  in the applications  they 
submit for hospital privileges. 
13  COMMENTS  OF  THE  DRAFT  REPORT 
We solicited  and received  comments  on the draft report  from the Public Health  Service 
(PHS),  the Assistant  Secretary  for Planning  and Evaluation  (ASPE),  the American 
Hospital  Association  (AHA),  and the American  Medical Association  (AMA).  We include 
the complete  text of their comments  in appendix C.  Below we summarize  the comments 
of the respondents  and,  in italics,  offer our responses. 
PHS COMMENTS 
The PHS noted our efforts  in working cooperatively  with the staff in the Health Resources 
and Services  Administration  and indicated that the report  will be helpful in administering 
the program.   It called for one minor change in the background  section of the report 
where we explain  the Data Bank law. 
We appreciate  the positive  response from  PHS.  We made the change requested. 
ASPE COMMENTS 
The ASPE commented  that the purpose  of our inquiry was  commendable  and that the 
survey methodology  seemed  appropriate.  It added,  however,  that the conclusions  we 
drew  are a matter  of interpretation  and that the findings of the report  could be used to 
support conclusions  other than those supported by the OIG.   It recommended  that we 
discuss why we conclude  that the Data Bank is useful when some evidence  in the report 
might be used to reach a contrary  conclusion. 
We did not draw the conclusion,  as ASPE  stated,  that the Data Bank is usefil.  In our

concluding  section,  we pointed  out that the data in the report contribute  to an

understanding  of the usefulness and impact of the Data Bank.  We indicated  that

assessments  of useji.dness and impact will depend heavily  on ones expectations  of the Data

Bank and the relative  emphasis given to them.  We then offered some pertinent

observations  concerning  each of three sets of expectations.

AHA COMMENTS 
The AHA indicated  that it was encouraging  that hospitals found Data Bank reports  to be 
more useful  and timely than during our prior  survey period.  However,  it raised  concern 
that the proportion  of reports providing  information  previously  unknown  to hospitals  has 
declined.  In elaborating  on that concern,  it suggested that the supplemental  role of the 
Data Bank in hospital credentialing  and privileging  efforts may come at too high a 
price.   It asked:  ...is the confirmatory  information  worth the significant  administrative 
and financial burdens  the Data Bank imposes on hospitals and other Data Bank users? 
We hope that the survey data we provided  on use@lness and impact will help readers 
answer that question for  themselves.  As we noted in our concluding  section,  ones 
14  assessment  of the value of the Data Bank will depend largely on ones expectations  of it in 
the jirst  place.  Further,  on the mutter of the declining propotiion  of Data Bank  reports 
providing  new information  to the hospitals,  we think it is quite possible,  as we noted in the 
report,  that the practitioners  increased awareness  of the Data Bank may well make them 
more likely to disclose any malpractice payments  or adverse actions  concerning  themselves 
before the hospital gets the information from  the Data Bank.  Thus, it is not just  that the 
Data Bank provides  confirmatory information  as xlHA noted,  but that it may also serve 
as a trigger for  information  that may not otherwise reach the hospitals. 
AMA COMMENTS 
The AMA,  like the AHA,  raised concerns  about the cost effectiveness  of the Data Bank. 
But it also raised  a number  of specific concerns  about our report. 
Its core concern  with our report  (as with our parallel  prior  report  of February  1993) is 
that it focuses on the universe  of matches rather  than queries.  In so doing,  the AMA 
indicated,  we end up offering misleading  conclusions  about usefulness  and impact because 
matches  represent  only about 4 percent  of all hospital queries to the Data Bank.  Along 
this line,  the AMA called  for us to include information  in the report  on the number  of 
queries.  It specifically  noted that our statement that  as of February  25,  1994, hospitals 
had received  in response  to queries,  108,552 reports  of malpractice  and adverse  actions 
was incorrect.  It added  that the word  matched must be inserted  between  108,552  and 
reports to reinforce  the fact that this report  is only looking at approximately  4.4 percent 
of the universe  of queries.  
The AMA added that in our report  we attempted to justi~  the low match rate and the low 
impact on credentialing.  It said that we did this by reporting  that 77 percent  of the 
respondents  found that Data Bank reports  with no adverse  information  on a practitioner 
were at least somewhat useful to them and that 71 percent  found it worthwhile  to query 
the Data Bank for all practitioners  as the law requires.  It commented  that the former 
statistic  may have been predictable  because the Likert  scale was skewed in favor  of 
providing  a positive  response  and the latter because  it simply elicited  a yes or no 
response.  Forty-two  percent  of those who explained  their response,  it said,  offered 
critical judgments  of the Data Bank. 
In addition,  the AMA commented  that (1) our report  would be strengthened  if we 
analyzed  matched  reports  on the basis of the reason hospitals  queried the Data Bank and 
(2) our draft  report  gave insufficient  attention to the finding that 5 percent  of hospitals 
found that the Data Bank match reports provided  them were incomplete.  This significant 
finding,  the AMA said,  should be included in the executive  summary  of our report  and 
should be addressed  immediately  by PHS. 
In 1992,  when we jirst  began our inquiries about the Data Bank,  we decided,  afier 
consultation  with various parties,  to focus  on the usejidness and impact of the information 
in the Data Bank,  as opposed to the overall utility of the Data Bank.  We determined  that 
such a focus  would provide  more discrete and practical  information  about what the Data 
15  Bank actually produces  and in so doing could contribute  to broader assessments  of the 
Data Bank.  We repeated that approach for  this report 10 allow for  comparative 
assessments  of the usefulness and impact of Data Bank reports over time.  We disagree 
with the xlM4  over the value of this approach. 
In response  to concerns expressed by MA  and some others about our prior  inquiry 
(concerning period  A),  we added the following  questions this time:  (1) How usefid to you 
are responses  that do not list any adverse information? and  (2) All things considered, 
do you feel  it is worthwhile  to query the Data Bank about all practitioners  in your  hospital 
as current law requires?  We believe the answers to these questions  o~er usejid 
perspectives  of key respondents  on the overall utiliy  of the Data Bank.  To MIAs  critique 
that the results we report on the first  question may overstate the positive  by reporting  that 
77percent  of the respondents found  the information  atleast somewhat  use@l, we note 
that total includes  26 percent  who regarded it as  extremely or very usefil  and 
27percent  as  moderately usefid.  To AMAs  critique that the results of the second are 
predictable  because  of the yes-no  response format,  we respond thut the simple format  was 
an unbiased  one allowing for  the respondent to express a basically positive  or negative 
response. 
In response to the MAs  suggestion,  we did clarl~  in our background  section  that the 
Data Bank  reports we refer to are  matched repotis.  However,  we did not provide 
additional  information  as the M  requested.  In an August  report entitled,  National 
Practitioner  Data Bank: Profile of Matches  Update (OEI-01-94-00031),  we offer 
extensive  data that provide  considerable perspective  on Data Bank matches. 
We agreed with the AMA  that if 5 percent  of the reports to the Data Bank were,  in fact, 
incomplete,  that would be a sigrdjlcant matter warranting  immediate  attention.  For that 
reason,  we conducted  a follow-up  inquiry and as we pointed  out on page  7, all of the 
reports cited by hospital  respondents as  incomplete turned out to be explainable  as 
timing  issues or as respondent  errors.  None involved actual nonrepotiing  to the Data 
Bank. 
Additional  analysis,  as MA  called for,  on the reasons for  hospitals  querying  the Data 
Bank  could be of some value,  but goes beyond what we can undertake  at this time. 
16
 APPENDIX  A 
METHODOLOGY 
For a summary  of our methodology for  the initial study period  @eriod A--9/l/9O  through 
3/19/92),  see Appendix  A of our report entitled  National Practitioner  Data Bank: 
Use@lness and Impact  of Repotis  to Hospitals  (February 1993). 
We collected  the data presented  in this report  for period B (March 20,  1992 through 
February  25,  1994) through  a mail survey of hospitals conducted  from May to July  1994. 
We drew  our sample from the universe  of all Data Bank matches  involving hospitals 
between  March  20,  1992 and February  25,  1994.  A match is a pairing  of a report  and a 
query to the Data Bank that name the same practitioner.  We requested  and received  a 
computer  file containing  records  of all Data Bank queries  and reports  that identified  the 
same practitioner.  We restructured  and analyzed the data using SAS@Release  6.08  on a 
mainframe  computer  and Version 6.04 of the SAS@System for Personal  Computers. 
We drew  a simple random  sample of 400 matches  from the universe  of 89,430 matches. 
This differs  from the sampling methodology  we used in period  A, which involved  a 
stratified  random  sample of 200 matches.  We increased  the sample size to lend more 
credibility  to our findings and to tighten contldence  intervals.  We choose not to stratify 
the sample because  we did find significant differences  on any key measure  by the 
stratification  variable  (type of report). 
In May  1994, we mailed  a questionnaire  about each report  to the hospital  involved.  There 
were 372 hospitals  that received  questionnaires;  22 hospitals were each sent questions  on 
2 different  practitioners  (1 of those hospitals received  a total of 3 questionnaires--1  for 
1 practitioner  and 2 for different  matches for another practitioner);  1 was sent 
questionnaires  on 3 different  practitioners,  and 1 was sent questiomaires  on 4 different 
practitioners.  We followed this with a second mailing  to nonrespondents.  All responses 
used in the analysis were received  by July 20,  1994.  Appendix B shows the questionnaire 
and simple frequencies. 
Questionnaires  were addressed  to the person  whose name appeared  on the original  query 
to the Data Bank.  Most respondents  held the position  of medical  staff coordinator  or the 
equivalent.  A few respondents  were the chief executive  officers  of their hospitals. 
Our response  rate was 64 percent.  Most of the responses  (89.5 percent)  concerned 
malpractice  reports;  10.5 percent  concerned  adverse action reports.  Overall,  malpractice 
matches  accounted  for 89 percent  of the universe  of matches,  so the distribution  of report 
types in our response  was as expected. 
Sixty-nine percent  of the respondents  queried  the Data Bank because  of mandatory 
A-1
 two-year  review  requirements,  29 percent  queried on initial privileging  or employment 
applications,  and 2 percent  queried for professional  review purposes.  Of the 27 responses 
based on adverse  actions,  63 percent  were State licensing board actions and 47 percent 
were hospital  clinical privileges  actions,  Ninety-three  percent  of the respondents  queried 
about physicians  (the other practitioners  were dentists,  podiatrists,  and nurse anesthetists. ) 
The specialties  of the physicians  are listed in table A. 
There  were 248 hospitals  represented  in the responses.  Of the 22 hospitals that had been 
sent questionnaires  about 2 practitioners,  10 responded,  but  1 responded  to only 
1 questionnaire  and the  1 that had received  3 questionnaires  (2 for  1 practitioner)  returned 
2 questionnaires  (1 for each practitioner).  Of the 2 hospitals that had been sent 
questionnaires  about more than 2 practitioners,  neither returned  any questionnaires. 
Unless otherwise  noted,  survey results presented  as percentages  have a margin  of error  of 
approximately  5 percent  at the 95 percent  confidence  level.  Confidence  intervals  for 
statistics cited for period  B in the body of the report  are summarized  in table B. 
A-2
 TABLE  A 
TYPES  OF  PRACTITIONER 
PERCENTAGEOF MATCHES 
NUMBER OF MATCHES 
TE OF PRACTITIONER 
100.0 
257 
)TAL 
92.6 
239 
IYSICIANS 
4.-
30  11.  / 
Obstetrics  and Gynecology

11.2 
29 
General  Surgery

8.6 
22 
Family  Medicine

8.3 
21 
Orthopedic  Medicine

6.6 
17 
Internal  Medicine

3.9 
10 
Missing

3.5 
9 
Emergency  Medicine

3.5 
9 
Neurological  Surgery

3.5 
9 
Eye,  Ear,  Nose,  and Throat

3.5 
9 
Plastic  Surgery

3.1 
8 
Urology

2.7 
7 
General  Medicine

2.7 
7 
Anesthesiology

2.3 
6 
Ophthalmology

1.9 
5 
Cardiology

1.6 
4 
Pulmonary  Medicine

1.6 
4 
Psychiatry

1.2 
3 
Oncology

1.2 
3 
Gastroenterology

1.2 
3 
Osteopathic  Gynecology

1.2 
3 
Radiology

0.8 
2 
Cardiac  Surgery

0.8 
2 
Dermatology

0.4 
1 
Thoracic  Surgery

0.4 
1 
Occupational  Medicine

0.4 
1 
Radiotherapy

Pathology
 11   (---)-.4  
4.3 
11 
DENTISTS  and ORAL 
SURGEONS 
2.7 
7 
PODIATRISTS 
0.4 
1 
NURSE  ANESTHETISTS 
I
Source:  (?ftice of InspectorGeneralSurveyof HospitalOf@als, May -July 1994 
A-3
 TABLE  B 
CONFIDENCE  INTERVALS  FOR  KEY  STATISTICS 
Description  Page  Value	 95 Percent Confidence 
Interval 
(+  or-) 
Proportion of reuorts considered useful  3  83.2 percent  4.7 percent 
Proportion of respondents rating licensing board actions  3  69.6 percent  5.8 percent 
extremely useful 
Proportion of respondents rating hospital actions extremely  3  68.3 percent  5.8 percent 
useful 
Proportion of respondents rating malpractice payments  3  39.8 percent  6.1 percent 
extremely useful 
Proportion of reports that provided information previously  4  28.0 percent  5.6 percent 
unknown 
Proportion of time learned of board actions from sources  5  33.3 percent  26.7 percent 
other than boarrl 
Proportion of reports on board actions that provided  5  8.3 percent  15.6 percent 
information previously unknown 
Proportion of reports on hospiral actions that provided  5  50.0 percent  30.1 percent 
information previously unknown 
Proportion of reports from other States hospitals were aware  5  69.7 percent  9.1 percent 
of 
Proportion of reports from own States hospitaIs were aware of  5  71.6 percent  7.3 percent 
Proportion of respondents indicating report was incomplete  6  4.7 percent  2.6 percent 
Proportion of respondents using electronic query.  6  25.6 percent  5.6 percent 
Proportion of reports that used electronic query and were  6  81.7 percent  9.8 percent 
found usetid 
Proportion of reports that did not use electronic query and  6  83.5 percent  5.6 percent 
were found usefil 
Proportion of reports that arrived prior to tlmal decision  7  83.2 percent  5.4 percent 
Proportion of reports that were not on-time because of a  7  5.8 percent  2.9 percent 
late query 
Proportion of reports that told hospitals about information  7  14.5 percent  5.4 percent 
they were aware of and was not consistent with it 
Proportion of respondents who find it worthwhile to query for  7  71.1 percent  5.8 percent 
all practitioners 
Proportion of respondents who find reports that do not list  7  47.2 percent  6.2 percent 
adverse information somewhat or not useful 
Proportion of respondents who fmd reports that do not list  7  26.0 percent  5.4 percent 
adverse information extremely or very useful 
Proportion of respondents who find reports that do not list  7  26.8 percent  5.5 percent 
adverse information moderately useful 
Proportion of reports with decisions pending  9  7.8 percent  3.3 percent 
Propordon of reports that made a difference in a decision  9  1.7 percent  1.6 percent 
A-4  TABLE  B 
CONFIDENCE  INTERVALS  FOR  KEY  STATISTICS 
Description  Page  Value	 95 Percent Cotildence 
Interval 
(+ or -) 
Proportion ofreports  that made  respondent more cotildent  9  26.1 percent  6.3 percent 
about a decision 
Proportion of reports that had little chance of impact  10  74.6 percent  5.6 percent 
Proportion of reports that practitioner did not go through  10  6,8 percent  3.2 percent 
credentialing process 
Proportion of reports not received prior to decision  10  11.4 percent  4.1 percent 
Proportion of reports provided information already know  10  56.4 percent  6.3 percent 
(though received on-time) 
Proportion of reports where respondents said at least part of  10  55.8 percent  6.5 percent 
the reason for no impact was that the reports did not warrant 
restricting or denying privileges 
Proportion of reports where respondents said at least part of  10  54.7 percent  6.5 percent 
the reason for no impact was that the reports gave them 
inforrnationthey afready were aware of 
Proportion of reports where respondents said at least part of  10  7.6 percent  3.5 percent 
the reason for no impact was that the reports did not arrive in 
time 
Proportion of reports where respondents said at least part of  10  3.1 percent  2.3 percent 
the reason for no impact was that they denied or restricted 
privileges anyway 
Propordon of reporls that could have had impact but did not  10  23.7 percent  5.4 percent 
Proportion of reports that could have had impact and were  11  12.0 percent  9.0 percent 
judged not useful 
Proportion of reports that could have had impact and yet did  11  76.6 percent  12.1 percent 
not indicate a problem warranting a change in privileges 
A-5
 APPENDIX  B 
SUMMARY  OF HOSPITALS  RESPONSES  TO OIG MAIL SURVEY 
B-1  U.S.  DEPARTMENT  OF HEALTH  AND  HUMAN  SERVICES 
USE AND  UTILITY OF THE

NATIONAL  PRACTITIONER  DATA BANK

NOTE:The first33 questionsinthis surveyconcernthecaseof PractitionerA, whoseidentityis givenon the 
lastpageof this questionnaire. Unlessotherwisespecified,pleaseconfineyourresponsestoyour knowledge 
of the particular practitioner and event referred to on that page. 
BASIC  FACTS  AND  CHRONOLOGY 
1  What  is Practitioner  As specialty?  31 d~ferent specialtiesrepresented  1 
2  On what date did Practitioner  A sign an application  2 
requesting  privileges  (either  new  or continued)  at your  mde range of dates 
hospital? 
3  On what date did you request  information  about  3 
Practitioner  A from the National Practitioner  Data  underange of dates 
Bank? 
4  Did you request  information  about Practitioner  A  Yes:61  4 
No:177 
using electronic  querying  methods  (QPRAC)? 
Missing:  19 
5  On what date did you receive  a response from the  5 
Dab  Bank?  (Write  ~  ~YOU  have  not  Yet eceived  ~w -~dea dr annogte reo~f ediayteesd a
a response.) 
response  yet 
6  On what date did the hospital board make its initial  wide range  of dates  6 
decision  regarding  Practitioner  As privileges?  write  ~e~~~~dfifl 
PENDING if boards  initial decision  has not yet 
been made,  then skip to 16.) 
7  (If YOU made your decision about Practitioner A prior  15 queried  after  7 
to receiving  information from  the Data Bank.)  Why  having  made  a 
decision
did you make your decision about Practitioner  As 
privileges  prior  to receiving  information  in response to 
the request? 
a  The response took too long to arrive.  yes: 0  a 
b  We had sufficient  information  already to make the  Yes:12  b 
decision. 
c  This request  was made outside of our credentialing  Yes:4  c 
process.  It was made for the following reason: 
NATIONALPRACTITIONEDRA  TABANKQUESTIONNAIR-E-P  AGE2 d  When wehave  received  adverse  information  from the  Yes:l  d 
Data Bank, ithasnot  beenusefil. 
e  We rarely  receive  adverse information  in response to  yes:s  e 
a request. 
f  The Data Bank responses  are not used in our  yes: 0  f 
credentialing  process  at all. 
g  Other  (EXPLAIN:  ~  es: 0  g 
8  Was the hospital boards  initial decision a temporary  Yes: 8  8 
one pending  fi.uther information?  No: 192 
Missing:  57 
9  (Sk@  if YOUanswered NO to 7)  wide range  of dates  9 
On what date did the hospital make its final decision  no final  decisions 
were pending 
regarding  Practitioner  As privileges?  (Write 
PENDING if boards jinal  decision  has not yet been 
made,  then answer 10 through 15 with respect to the 
boards  initial decision.) 
10  Were  privileges  granted to Practitioner  A as requested  ~oS~:~  10 
by Practitioner  A? 
Missing  or N/A:  44 
11  (Skip if you answered  XES to 10)  Yes: 5  11 
No: 6 
Were  Practitioner  As  privileges  denied  (for  initial 
Missing  or NJA:246 
application)  or revoked  (for  renewal  application)? 
12	 (Skip if you answered  YES to 10 or 11)  Yes: 3  12 
Were  Practitioner  As privileges  restricted  or amended  0:3 
Missing  or N/A:  251 
in any way? 
13	 (Skip  if you answered  YES to 10 or 11 or NO to 12)  13 
In what  way  were  Practitioner  As  privileges  restricted  or  amended? 
a  All privileges  suspended  (IF  YES,  FOR  HOW  yes: O  a 
LONG?~ 
b  May not perform  certain procedures  Yes:O  b 
c  May perform  certain procedures  only with another  yes: I  c 
practitioner 
d  May co-admit patients only  Yes:O  d 
e  Mandatory  consultation  for certain  conditions  yes: 0  e 
f  Mandatory  review before patient  admission or  Yes:O  f 
discharge 
g  Proctor  assigned to review Practitioner  As work  yes: O  g 
NATIONAL  PRACTITIONER  DATA BANK  QUESTIONiVAIM  -- PAGE  3  Yes:2  h 
h  Other (IF YES,  SPECIFY: 
) 
14

Yes: 2 
14  (Skip if you answered  YES to 10 or 11 or NO to 12)  No:2

Were  these restrictions  on Practitioner  As privileges  Missingor N/A:  253

in place prior  to the application? 
(Check one)  15 
15  (Skip if you answered  YES to 10 or 11 or NO to 12) 
Which  of the following best describes the restrictions 
applied to Practitioner  As privileges? 
o  a 
Routine  (e.g.,  procedure(s)  not approved  at this 
a 
hospital,  restriction  applied to all new hires,  etc.) 
2 b 
b  Specific to Practitioner  A (e.g.,  applied because  of 
particular  event(s) in Practitioner  As histo~) 
16 
Yes: 13 
16  Were  any other actions taken with regard  to  No: 224

Practitioner  As employment,  privileges,  or  Missing or N/A:  20

credentials  (e.g.,  education  requirements,  drug testing, 
etc.)? 
(IF YES,  EXPLAIN: 
) 
NATIONZ4L PRACT~IONER  DATA BANK  QUESTIONNA~  -- PAGE  4  AVAILABILITY  AND  ACCURACY  OF INFORMATION 
117  Were  you  aware,  from  sources  other  tian  tie  Data  Yes:175  17 
No: 72
Bank,  of theadverse  action  or malpractice  payment 
Missing  or N/A:  10 
mentioned  on the last page of this form? 
18 
18	 (Sk@ if you answered NO to 17) 
From  which  of the  following  sources  were  you  aware  of the  adverse 
action  or malpractice  payment? 
a  Practitioner  A (self-report)  ~os:~~  a 
. 
N/A:  72 
Missing:  3 
b 
b  Licensing board  in your state  yes:17 
No:154 
N/A:  72 
Missing:  4 
c  Licensing  board in another  state  yes:3  c 
No: 168 
N/A:  72 
Missing:  4 
d  Malpractice  insurer  in your state  yes:35  d 
No: 136 
N/A:  72 
Missing:  4 
e  Malpractice  insurer  in another  state  yes:4  e 
No: 167 
N/A:  72 
Missing:  4 
f  Other hospital in your state  yes:13  f 
No: 158 
N/A:  72 
Missing:  4 
g  Hospital  in another  state  yes:5  g 
No:166 
N/A:  72 
Missing:  4 
h  Professional  society in your state  Yes:z  h 
No: 169 
N/A:  72 
Missing:  4 
i  Professional  society in another  state  yes:Z  i 
No:  170 
N/A:  72 
Missing:  4 
NATION~  PRACTITIONER  DATA BANK  QUESTIONNAIRE  -- PAGE  5  j 
Other source in your state  Yes.16 
j 
(IF YES,  SPECIFY:  ~A1~ 
)  Missing:  5 
1 
k 
Other source in another  state  yes:3 
k 
(IF YES,  SpECIFy:  ~A~; 
)  M&g:  7 
19

Yes: 24 
19  (Skip if you answered NO to 17)  No: 142

Was the information  you received  in the Data Bark  Missing  or N/A:  91

response  inconsistent  in any way with the information 
reported  by any of the above sources? 
(IF YES, WHICH  SOURCES? 
) 
Yes: 48  20

20  Did you make additional  inquiries  (for example,  to a  No: 197

malpractice  insurer  or another hospital) to confirm the  Missing  or N/A:  12

accuracy  of the Data Bank response  or to obtain more 
detailed  information  on its content? 
21

Yes: 40 
21  (Skip  if  you anwered  NO to 20)  No: O 
Did your additional  inquiries  show the Data Bark  Missing  or N/A:  217 
response  to be accurate? 
(IF NO,  EXPLAIN: 
\ 
J 
NOTE:Questions22-25refertotheentireDataBankresponse,notjust tothereportattachedto this 
questionnaire. Therefore,ifyoureceivedmorethanonereportfromtheDataBankonPractitionerA, 
pleaseconsiderthemall in answeringQuestions22-25. 
22 
Yes:20 
22  Were  you  aware  of any  disciplinary  actions,  or  No: 228 
malpractice  payments  involving  Practitioner  A that  Missing  or N/A:  9 
were not  contained  in the response from the Dati
Bank? 
23 
23  you anwered  NO to 22) 
(Skip  if 
How many disciplinary  actions and malpractice  payments  were you aware 
of that were ~t  contained  in the response from the Data Bati? 
a 
Number  of disciplinary  actions  I rew. aware  of I 
a 
2 aware  of 3 
1 aware  of 4 
b 
Number  of malpractice  PaYments  ~~~~rea~fl f 1 
b 
1

1 aware  of 3 
1 aware  of 7 
1 aware  of 11 
NATIONAL  PRACTITIONER  DATA BANK  QUESTIONNAIW  -- PAGE  6  24	 (Skip if you answered NO to 22)  24 
How many of these disciplinary  actions and malpractice  payments 
occurred  @  September  1, 1990? 
a  Number of disciplinary  actions  ~ w.  aWWeof ~  a 
1 aware  of 2 
b  Number  of malpractice  payments  d w  awareOf~  b 
4 aware  of 2 
1 aware  of 5 
25	 (Skip if you answered  NO to 22)  25 
Which  of the following  sources provided  information  about disciplinary 
actions or malpractice  payments that were n- contained  in the response 
from the Data Bank? 
a  Practitioner  A (self-report)  yS18  a 
b  Licensing board  in your state  yes:~  b 
c  Licensing board  in another state  y~~:~  c 
d  Malpractice  insurer  in your state  yes:3  d 
e  Malpractice  insurer  in another state  yes:~  e 
f  Other hospital  in your state  Yes:5  f 
g  Hospital in another  state  Ye:~  g 
h  Professional  society in your state  Yes:~  h 
i  Professional  society in another  state  yes:~  i 
j  Other source in your state  Yes:3  j 
(IF YES, SPECIFY: 
) 
k  Other source in another state  Ye:~  k 
(IF YES,  SPECIFY: 
) 
NATIONAL  PRACTITIONER  DATA BANK  QUESTIONNAIRE  -- PAGE  7  CONSIDERATION  OF INFORMATION 
26	 Based on the notes in Practitioner  As file and your personal  knowledge  26 
of Practitioner  As application,  which of the following people  or groups 
had access to and used the response from the Data Bank in making a 
decision  regarding  Practitione~ As application? 
a  Department  chair  Yes: 183  a 
NO: 60 
Missing  or N/A:  14 
b  Chief of medical  staff  Yes: 148  b 
No: 95 
Missing  or N/A:  14 
c  Hospital  administration  (CEO,  Vice President,  etc.)  Yes: 139  c 
No: 104 
Missing  or N/A:  14 
d  Credentials  committee  Yes: 192  c1 
No: 48 
Missing  or N/A:  17 
e  Medical  staff executive  committee  Yes: 164  e 
No:  78 
Missing  or N/A:  15 
f  Hospital board  subcommittee  Yes: 71  f 
No: 162 
Missing  or N/A:  24 
g  Full hospital board  Yes: 138  ~ 
No: 104 
Missing  or N/A:  15 
NATIONAL  PRACTITIONER  DATA BANK  QUESTIONNAIRE  -- PAGE  8  UTILITY  OF INFORMATION

27  Including  the report  on the last page,  how many Data  Range from  1 to  27 
Bank reports  on Practitioner  A did YOUreceive  in to~l  ~~~~s~ =$ 
from this request? 
missing or NA,  89

had multiple  reports.

Ave:  2.98  repo?ts

28  (Skip if you answered  1to 27)  Yes: 71  28

Overall,  was the information  contained  in the  No: 12

Missing  or N/A:  174

complete  Data Bank response  (i. e.,  all reports 
combined)  useful to you? 
IF YES, WHY?  (Check all that apply) 
a  Information  was unavailable  elsewhere  Yes:  21  a 
b  Information  confirmed  other reports that were  Yes:  49  b 
available elsewhere 
c
 Information  helped us to judge practitioners  Yes: 25  c 
competency 
d  Information  helped us to judge practitioners  Yes: 15  d 
professionalism 
e
 Other  (EXPLAIN:  )  Yes: 2  e 
IF NO, WHY NOT?  (Check all that apply) 
f  Information  was available  elsewhere  Yes:  13  f 
g  Information  was inaccurate  Yes: 1 g 
h  Information  did not help us to judge practitioners  Yes: 8  h 
competency  or professionalism 
i  Information  was not provided  in a timely manner  Yes: 2  i 
i  Other  (EXPLAIN:  )  Yes: 4 j 
29  (Skip if you answered  1to 27)  Yes: 2  29 
Would your decision regarding  Practitioner  A have  No: 84 
Missing  or N/A:  171 
been different  if you had D@received  the reports  from 
the Data Bank? 
IF YES, HOW  (then skip to 31)?  (Check one) 
a  Would have granted requested  privileges  Yes:  O  a 
b  Would not have granted requested  privileges  Yes: 1  b 
c  Would have restricted  privileges  Yes: 1 c 
d  Would not have restricted  privileges  Yes: O  d 
NATIONAL  PRACTITIONER  DATA BANK  QUES7TONNAW  -- PAGE  9  e

>  Other (EXPLAIN:  ~  s:  0 
(Check all that aPPIY) 
IF NO, WHY NOT? 
fl 
f  Would have restricted  or denied privileges  anyway  :2 
g 
g  Already knew,  from other sources,  about information  yes:51 
reported  in Data Bank responses 
h 
h  Data Bank responses  did not indicate a problem  that  yes:42 
warranted  restricting  or denying privileges 
i 
i  Did not receive  Data Bank responses  in time	 to affect  es: 3
decision 
J 
j  Other (EXPLAIN:  ~  s2 
30 
(Skip if you answered  YESto 29) 
Did  the  reports  you  received  make  you  feel  more

(Check  one)

cotildent,  less  confident,  or no different  about  the 
decision you made regarding  Practitioner  A?

180 
Missing 
25 
More  confident 
a 
1 
cotildent  2 
LZSS 
b 
( 
NO different  48 
c 
yes:  203  31 
Overall,  was the information  contained  in the Data  No: 40 
Bank report  on the last page useful to you?  yes  and No: 1 
Missing  or N/A:  13 
(Check all tit  aPPIY) 
IF YES, WHY? 
~ 
Information  was unavailable  elsewhere  Yes:51 
a 
1 
b  Information  confirmed  other reports  that were  YS:132 
available elsewhere 
c  Information  helped us to judge practitioners  YS:64 
competency 
Information  helped us to judge practitioners  yes:50
d 
professionalism 
e  Other  (EXPLMN:  ~  es: 12 
(Check all that RPPIY)
IF NO, WHY NOT? 
f 
Information  was available elsewhere  yes:30 
f 
g 
c  woulmz?iz$~~a  j!i%fkri~  ~  ~ 
d 
Would not have restricted  privileges  YS:O 
d 
NATION&  PRACT~IONER  DATA BANK  QUESflONNA~  -- PAGE  9  h 
h  Information  did not help us to judge practitioners  yes:18 
competency  or professionalism 
1

Yes:  7 
i  Information  was not provided  in a timely manner  II

)  yes: 6  j 
Other (EXPLAIN: 
j 
32

Yes: 5 
Would your decision regarding  Practitioner  As  No: 227

privileges  have been different  if you had n~  received  Missing or N/A:  25

the report  on the last page from the Data Bank?
IF YES, HOW? 
a 
Yes: 2 
Would have granted requested  privileges 
a 
b 
Yes: 2 
Would not have granted requested  privileges 
b 
c 
Yes: 1
Would have restricted  privileges 
c 
d 
Yes: O 
Would not have restricted  privileges 
d 
)  Yes:2 d 
e  Other (EXPLMN: 
(Check all that WPIY) 
IF NO, WHY NOT? 
I 
Yes: 7 
Would have restricted  or denied privileges  anyway 
Yes:  122  f 
Already  knew,  from other sources,  about information 
reported  in Data Bank response 
1 
Yes:  125 
Data Bank response did not indicate a problem  that 
warranted  restricting  or denying privileges 
i  Did not receive  Data Bank response  in time	 to affect yes:17
decision 
)  Yes:  10 
Other  (EXPLAIN: 
j 
33 
3  (Skip if you answered  =S  to 32) 
Did the reports  you received  make you feel more 
(Check  one) 
confident,  less confident,  or no different  about the 
decision You made regarding  Practitioner  A? 
67 
Missing 
49  a 
confident 
a  More 
confident  7  k 
uss 
b 
132  c 
NO different 
J 
c 
NATIONZ4L PRACT~ONER  DATA BANK  QUESTIONNAIRE  -- PAGE  11  NOTE:  The remaining  questions do not concern  the  specific case  of Practitioner 
A, but rather  your general  experience  with and attitudes about the Data Bank. 
GENERAL  QUESTIONS  ON THE

NATIONAL  PRACTITIONER  DATA  BANK

34	 How,  if at all, have the other parts  of your credentialing  procedures  been  34 
affected  by the availability  of the Data Bank? 
25 respondents  discussed  how the process  is more  costly  or has been delayed  by the Data 
Bank,  24 discussed  how hiring  or granting  of privileges  now is dependent  upon first 
receiving  the Data  Bank  response,  22 discussed  how the Data Bank  que?y is required  for 
all applicants,  and 22 discussed  how the Data  Bank is used to verify  information  on 
practitioners  applicahon.  A host of other  changes  were mentioned  by other respondents. 
35	 Please rate the following  four types of information  maintained  in the Data  35 
Bank in terms  of their usefulness  to you--in practice  or in theory--in  the 
practitioner  credentialing  process.  (Let 1 =  extremely  useful and 
4  =  not at all useful.) 
a  Hospital  disciplinary  actions/privilege  restrictions  ~TING:  a 
Mean:  1.53 
S. D.:  0.89 
b  Licensing  board  actions  ~TzNG:  b 
Mean:  1.53 
S. D.:  0.92 
c  Malpractice  payments  ~TING:  c 
Mean:  2.00 
S.D.: 0.99 
d  Professional  society disciplinary  actions  ~TzNG:  d 
Mean:  2.25 
S. D.:  1.18 
36  How useful to you are responses  from the Data Bank  (Check  one)  36 
that do not list any adverse  information? 
Missing  6 
a  28 
Extremely  useful  a 
b  Very useful  37  b 
c  Moderately  useful  67  c 
d  Somewhat useful  60  d 
e  Not useful  58  e 
Please explain:  22 explained  that it confirms  information  provided  by other  sources 
ijositive);  7 felt  the Data  Bank  was incomplete  or had insuf~cient  informatton. 
NATIONAL  PRACTITIONER  DATA BANK  QUESTIONNAIRE  -- PAGE  12  37  All things considered,  do you feel it is worthwhile  to  Yes: 170  37 
query the Data Bank about all practitioners  in your  No:  69 
Missing: 18 
hospital  as current  law requires? 
Please explain:  25felt  it was usejid  because  it provided  useful  documenttion  for 
credentialing  or priwlegng; 18 felt  it was not worth the tzmeor money. 
38	 What kind of information  ~  currently  maintained  by the Data Bank  38 
would be useful to you? 
39	 Please  list any additional comments  and suggestions you have about the  39 
operation  of the National Practitioner  Data Bank. 
This is the end of the survey.  Thank you for taking the time to complete  it.  Please return 
your completed  survey in the business-reply  envelope to: 
Office of Evaluation  and Inspections

Office of Inspector  General

U.S.  Department  of Health and Human Services

Room 2475, J.F.K.  Federal  Building

Boston,  MA 02203

If yOUhave questions,  please call David Veroff or Barry McCoy at 617-565-1050. 
NATIONAL  PRACT~ONER  DATA BANK  QUESTIONNAIRE  -- PAGE  13  APPENDIX  C 
COMPLETE  COMMENTS  ON THE DRAFT REPORT 
c-1  S-U*,< ~ 
/4+ 
. 
. DEPARTMENT  OF HEALTH  & IIIJhlW  SERVICES  Public He.akh Suvica 
3
9
%,
%,,, 
Memorandum 
FEB2fm 
OfIte 
Assistant  Secretary  for  Health 
hom 
Office  of  Inspector  General  (OIG)  Draft  RepOxtS  on  the 
subject

usefulness  and  Impact  of  National  Practitioner  Data  Bank 
Reports  to  Iiosp~talS  and  Managed  Care Organizations, 
OEI-01-94-00030  and  OEI-01-94-00032 
To 
Inspector  General,  OS 
Attached  are  the Public  Health  Servi-ce  comments  on  the  subject 
OIG draft  reports.  We  appreciate  the efforts  of OIG  6taff  in 
developing  these  reports.  We offer  only a few general 
comments  and  a  sugges~ed  editorial  change. 
(j#/$  L 
42 
Philip  .  Lee, M.D. 
Attachment  ~PBLH  T  S  RVICE  P  OFFICE  OF  XNSPECTOR 
GENEM  (OIG)  DRAFT  REPORTS  ON THE USEFULNESS  AND  IMPACT  OF THE 
NATTONAL  PRACTITIONER  DATA BANK TO  HOSP TALS  AND MAXAGED  CAR 
~R 
DECEMBER  1994

The  OIG  inspections  were  performed  at  the  request  of  the  Health 
Resources  and  Services  Administration  (HRSA).  The  HRSA asked  OIG 
to  update  the  February  1993  inspection  report  on  the  usefulness 
and  impact  of  National  Practitioner  Data  Bank  reports  to	
hospitals,  and to  consider  the Data  Banks  relevance  to managed

care  organizations.	
we  appreciate  the  efforts  of the OIG staff and  their  cooperation	
with  program  officials  in  HRSA  in  developing  these  reports.	
These reports  reflect  many  of  the  changes  that  we  suggested  to	
OIG  staff  during  the  exit  conference  and  on  subsequent  occasions.

we  believe  that  these  xeports  will  be  helpful  in  administering	
the  program.	
Nevertheless,  we believe  that a wording  change  is  needed  to	
pxovide  greater  clarity  in  the  Background  section  of  the	
Executive  Summary  of  both  reports.  The  first  paragxaph  in  these	
sections  states  thaC  [Hospitals  are  required  to  request	
information  from  the  flata  Eank  about  every  physician  and  dentist	
who  applles  for  appointment  (they  must  qu=yat  least  every  two	
years).    The  requirement  might  be  better  understood  by  readers	
if  the  parenthetical  phrase  was  deleted  and  replaced  with  the	
following  sentence:  In  adciition,  hospitals  nmst.query  at  least	
once  every  two  years  on  every  practitioner  who  ~S  on  ~hei=	
medical  staff  or  who  has  privileges.  	 /-4%   
i  (L OEPARTMENTOF  HEALTH&  HUMAN  SERVICES  -ice  d theSecrelaw 
s %
s  t-
s

Weshinglon,  O.C.  20201 
FEB  27  W5
To:  JuneGibbs Brown 
Inspector General 
From:  Assistant Seeretary for 
Planning and Evaluation 
Subject:  OIG Draft Reports on the Usefulness and Impact of the National Practitioner 
Data Bank 
I have reviewed  two draft inspection reports entitled, National Practitioner Data Bank 
Reports to Hospitals:  Their Impact *d  Usefulness and National Practitioner Data Bank 
Reports to Managed Care Organizations: Their Impact and Usefulness.   The purpose of the 
sumeys, as indi-ted  in the title+ is to determine if the users consider the data bank to be 
usefid in making  decisions  about  granting  privileges  to physicians,  The  purpose of OIGS 
inqui~  is commendable and the survey  methodology  seems appsupriate. 
1 think,  however,  that the conclusions  dxawn by OIG are a matter of interpretation  and that 
the findings of the report cadd  be used to support conclusions other than those drawn by 
OIG.  For example,  the findings from the survey of managed care entitiessuggest that the 
data bank is, contrary to 010s  contention, duplicative as indicated by the following 
responses. 
Officials said they setdom or rarely relied on a report from the data b~k  indeciding 
to deny privileges.  In fact, only 8% (questionnaire item 27, page 8) of the 
information was reported unavailable elsewhere.  This implies that 92% found the 
information available elsewhere. 
The major finding that supports the OIGSconclusion of data bank  usefulness is the 
answer to the question,  OvcralI,  was the information  contained  in  the complete  Data 
Bank response (i.e.,  all reports combined) useful 10you?(questionnaire item 27, 
page 8).  Of those who answered,  96% said yes; however, only 60 of 200 
respondents or 30!%of the sample answeml  the question.  One em~d interpret  this 
finding to indimte  that only 30% of the sample could answer positively. 
I recommend  that OIG discuss why its conclusion that the data bank  is useful is a better 
reading ofthe evidence than the -conc%lusion reac%hed ab~ %-- s= 
Prepar4  by; Mary  Bymes  690-7388  American  Hospkal  Association 
One  North  Franklin 
Chicago,  IIlino!s tI0606 
Telephone  312.422.3000 
February  6,  1995	
.June Gibbs  Brown	
Inspector  General	
Office  of Inspector  General	
Department  of Health  & Human  Services	
Washington,  D.C.  20201	
Re:
 Draft  Repoti  - National  Practitioner  Data  Bank  Reports  to Hospitals:  Their  Usefulness 
ond Impact 
Dear  Ms.  Brown 
The  American  Hospital  Association  (AHA),  on behalf  of its 5.000  hospital  members.  welcomes 
this  opportunity  to comment  on the  OffIce  of Inspector  Generals  draft  report  on the usefulness 
and  impact  of National  Practitioner  Data  Bank  reports  to  hospitals.  Because  our  members  are 
principal  users  of  Data  Bank  information  and  the  chief  financial  support  for  Data  Bank 
operations.  the AHA  is exttemely  interested  in knowing  how  hospitals  use  this  information  and 
whether  it is useful  to them  during  the credentialing  and  privileging  process. 
According[othedraft,  hospitals  are finding  Data  Bank  information  both  more  useful  and  more 
timely  than  in  a  previous  survey,  conducted  shortly  ~f~r  [he  Dam  Bank  WaS imPlemen~d 
Although  these  findings  are  encouraging,  OIG  also  reports  that  the  proportion  of  ne w 
information  the Data Bank  supplies  actually  has declined.  While  there  may  be some  value  in the 
supplemental  r(~le the  Data  Bank  seems  to  have  assumed  in  credentialing  and  privileging,  we 
question  whether  that  role  comes  at  too  high  a  price.  In  other  words,  is  the  confirmatory 
informs tion ~vorth the significant  administrative  and financial  burdens  the Data  Bank  imposes  on 
hospita!s  und other  Data  Bank  users? 
In short.  although  we  are  pleased  that  a  greater  percentage  of  hospitals  fmd  the  Data  Bank 
generd[ly  usetiJ.  we are concerned  that  Data  Bank  information.  acquired  pursuant  to statutory 
mandute  md  at  high  cost  to  users,  is  not  proving  appropriate  to  and  effective  in  hospital 
decisionmaking. 
Sinwrcl\. 
/  ,,$:  herican  Medical  Msociation 
PfivwcmtmdediCJlt@(IIlhPMMh  II( Arnerir;t 
ham  S. TeddM, D  516NorthStareStrwt  3[2464-5000 
Esemtive  Vice FresldQnt  Chkago, Illinois  60610  312464-418Fa4x 
February 1, 1995 
The Honorable June Gibbs Bruwn 
Inspector General

Office of Inspector General	
Department of Health and Human Services	
330 hxiependenec Avenue, SW - Room 5246	
Cohen Building	
Washingmn, D.C. 20201	
f)raft Inspection Repon. ~moml  Praaitioner Dara Bank Reporrs to Hospirals: 
2-
The /&erican  Medicai Association (AMA) is pleased to respond to your request for 
comments on the OffIce of Inspwor  ~ne=ls  (010  draft inspection report, National 
Practitioner Data Bati  Repofls ~0 Hos@ak  Iheir Usefdness and Impacr, Decernkr 
1994.  l%c SQ~d  PWPOSCOf this s~dy  was (O update an assessmenotf tic  usefulness and 
impact of information in M  Natiod  Pmctit~onerData Bank (NPDB) to hospitals. 
After reviewing  the December draft report, the AMA concludes that the report only 
partially addresses the useflhess  and impact of the NPDB aud doea not agtec  with  the 
concluding observations.  The AMA is very disappointed to see she serious flaws wc 
identifiiendt
he February, 1993 OIG rcpon  repea@d in this report.  The AMA  offers  the 
followincgo mmentsonthedraftreport.

The draft  report  again fafls to di=lo=  the toti  universe  of queries  or any operational 
information.  Since he  AMA citi  this m.arm as a most serious deficiency in the 
Fcb~~,  1993 rtport,  the MA  qucs~o~  WhY@  OIG is not P=cn@!  a m~m 
comprehensive and accurate assessment of h  usdikss  and impactof the NPDB.  TM 
AMA believes that some of the critical information from the August, 1994 OIG report, 
Natioml Pnrctizimer Data Bmk:  Profile of h.ialchesUp&ate,must be id.tiiedin this 
currenrteport,  For example, the foIlowing information needs to be included in the 
background section of the drafi report 
As of April,  1994, the Data Bank had received 3,462,297  requests for information 
and 82,623 reports of adverse actions or malpractice pqmwnts.  As 8 rtsd  Of M 
queries made by April of 1994, 152,941 matches had occurred (144,649 matches 
as of February of 1994).  Page 2	
February 1.1995	
The Honorable June Gibbs Brown	
IMSinformation provides a match me  of 4.4  percent.  Ninety-six percent of the queries 
resulted in no adverse action or malpractice information.  The background  section of the 
draft report presents a wry  different pictw=.  The draft report states,  as of February 25, 
1994, hospi~s  had received. in response to queries. 108.552 reports of malpractice 
payments Or adverse  aCtiOIKSagainst  physicians. dentists, and other health care 
practitioners.   This statement is wrong.  The AMA believes that the word matched 
must be inserted between  108,552  and  reports  to rein.forcethe fact that this report is 
only looking at approximately 4.4 percent of the universe  of queries. 
The report would be swengthened if the 010  would anaiyze tie  matched reports baaed on 
the reason the hospitid was querying the NPDB.  Of those rcspondema who queried  the 
data bank, 69 pcmem did so co meet their statutorily mandated two year rquirememsf  29 
Pement didsoon initial privileging  or employment applications. and 2 pereent did so for 
professional review purposes.  That analysis demonstrates that matches for initial 
applicants may be more imPor@ntthan if a practitioner was being tmerkmtialed.  In the 
Februay.  1993 OIG repofi. 42 percem queried on initial privileging or ernpioymcm. 
This change in the reason for the query could  be why the utdmovvninfomnation decreased 
from 40 pemcnt to 28 petcent. 
The draft repro  stares that 83 percentof hospi~  officials in period B now consider the 
matched reports useful compared to 58 percent in period A.  Again, however, the major 
reason was that the information only cofilrmed  other reports that were available 
elsewhere.  The draft report atr.emptsto justify the low match rate and impact on 
crcdent.iaiing by stating that 77 pement of the respondents found thatno adverse 
informatiownas at least somewhat usefid and 71 pereetn found it worthwhile to query as 
rhe current law requires.  These resuks  may have km  predictable  because the Likert 
scale was skewed  in favor of providing  a positive  response,  and the other question  was to 
elicit a simple  yes or no response.  Forty-two  petunt  of the  respondents  who explained 
their response stated that tie  NPDB wss not WOrththe tune or money. 
The AMA was pleased to see that the NPDB response time had impruved significantly. 
However. the AMA is very conccmed about growing evidence that the NPDB is not 
rcporcingall the information it should to hospiuds.  Almost S pement of the hospiuds 
idicated  that the match report was incomplete.  This indicates that there arc serious 
problems  whh  the matching  algorithm  or how the reports are being entered into the 
NpDB  files.  Since many hospitals justifi  the usefulness  on conftrmatiott  of information, 
[his growing  trd  raises questions  about the  reai Usefidness.  The AMA bdieves  r-hat 
this is a significant  f~ing  and should be included  in tie  executive  summary  portion  of 
thc RPOR.  In addi~ion. tie  ~biic  Heajt~ sc~lce  n=ds  (O ~C  im.m~~te  SWPStO 
identifi rhe problem  and correct  it.  Page 3	
Fcbxuary 1.1995	
The Honorable June Gibbs Brown	
The  most impo~nt  indi~tor  of usefulness is whe~er ~  ma~h~  repons had an impact	
on crcdemialing decisions.  AlthoughperiodB shows a slight improvement over period	
A, only 2 percent of ~C ma~h~  rCPOHSmade a diffemflcc in a privileging decision 
compared  to 1 percent in period A.  Whh a match rate of 4.4  percent  and only  2 percent 
of matchedrepom hv~g  m impct  on privileging. M  ovcd  hpact  is 0.09  percentor 
about one out of every 1.100 queries.  After review of the draft report. the MUA 
seriously questions  thc OIGS concluding  observations.  The growing  trend  of tiw NPDB 
failing to provide complete information on a practitioner with an adverse action report 
and/or a ma]prac~icepayment rcpott rakes serious conoetns ah  NPDB reliability as a 
centralized source of Mo-tion.  In addition. tie  Dam Bank is not a cost-effective 
mechanism  to protect  the public  by preventing  incompetent  -or  unprofessional 
practitioners  from practicing in hospitals.  Very rarely did an NPDB query affect 
privileging decisions of hospnrds.  Only 0.09 percent of the queries affect a credentiaiing 
decision. 
here  is also no data presented  to suggest that hospitils  are overly  reluctant  to take 
adverse actions against incompetent and/or unprofessional  practitioners.  ln fact.  hospitals 
and their medical  staffs MC t.ddng SWPStO enh=c  their  continuous  quaiity  improvement 
programs  to improve  their patient  care. 
It is difllcult to justify tie dtit  ati  indirect costs of operating the NPDB to provide 
reports that did not chmge nything  or provided  information  hat  simpiy confirmed 
information thatwas already known.  We urge you to consider our comments in order to 
adequately assess the utility and impact of the NPDB to hospitals. 
krnes S. Todd, MD  APPENDIX  D 
NOTES 
1.  Department  of Health and Human Services,  Officeof  Inspector  General,  Mzti7mal 
Practitioner  Data Bank: Profile of Matches  Update, 0EI-01-94-OO031, 
August  1994. 
2.  Department  of Health and Human Services,  Office of Inspector  General, 
National  Practitioner  Databank:  Useji.dness and Impact  ofReports  to Hospitals, 
0EI-01-90-O0520,  February  1993. 
3.  Thirty-eight  percent  rated professional  society action reports  extremely  usefhl. 
4.  Department  of Health  and Human  Services,  Public Health  Service,  Health 
Resources  and Services Administration,  Bureau of Healti  Professions,  Division  of 
Quality Assurance,  National  Practitioner Data Bank:  Third Annual  Report 
(September,  1992 -August  31,  1993),1993,7. 
5.  Of the  17 percent  of reports  found not useful,  this is the primary  reason they were 
found not useful. 
6.  Over 23 percent  did not answer why the reports  did not have any impact  on their 
decisions. 
7.  We are 95 percent  confident that the proportions  of reports  that provided  new 
information  to hospitals  is between 20,033  and 30,048. 
8.  We are 95 percent  confident that the proportion  of reports  that affect hospital 
credentialing  decisions  is between 45 and 2,995. 
D-1