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

USEFULNESS  AND  IMPACT  OF  REPORTS

TO  STATE  LICENSING  BOARDS

MARCH 1993
 OFFICE  OF  INSPE~OR  GENERAL 
The  mission of the  Office of Inspector  General  (OIG),  as mandated  by Public Law 95-452, as 
amended,  is to protect  the  integrity  of the  Department  of Health  and Human  Semites  (HHS) 
programs  as well as the health  and weifare  of beneficiaries  sewed  by those  programs.  This 
statutory  mission  is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the Office Of  Audit  Semites,  the 
Office of Investigations,  and the  Office of Evaluation  and Inspections.  The  OIG  also informs 
the Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
, 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGS Office  of Audit  Sewices  (OAS)  provides  all auditing  services  for 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  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency throughout  the Department. 
OFFICE  OF INVESTIGATIONS 
The  OIGS Office  of Investigations  (01)  conducts  criminal, civil, and administrative 
investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of 
unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions, 
administrative  sanctions,  or civil money  penaities.  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  OIGS Office  of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and 
program  evaluations  (called  inspections)  that  focus on issues of concern  to the Department, 
the Congress,  and  the public.  The  findings and recommendations  contained  in these  inspection 
reports  generate  rapid,  accurate,  and up-to-date  information  on the efficiency, vulnerability, 
and effectiveness  of departmental  programs. 
This report  was prepared  under  the direction  of Mark  R. Yessian,  Ph. D., the Regional 
Inspector  General,  and Martha  B. Kvaal, Deputy  Regional  Inspector  General,  Boston  Region, 
Office of Evaluation  and Inspections.  Participating  in this project  were  the  following  people: 
Boston Region  Headquarters 
David Veroff, R@ect Leader  Alan  Levine 
David Schrag, Lead Analyst 
For additional copies of this repo~  please contact the Boston Regional Office at 
(617) S6S-105O.  Department  of  Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENEML 
DATA  BANK:

NATIONAL  PRACTITIONER 
OF  REPORTS

USEFULNESS  AND  IMPACT 
BOARDS

TO  STATE  LICENSING 
MARCH  1993  OEI-01-90-00523
  EXECUTIVE  SUMMARY 
PURPOSE 
The  purpose  of this study is to assess the  utility  of National  Practitioner  Data  Bank 
reports  to  State  licensing  boards. 
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,  State  licensing  boards,  and  professional  societies  against 
licensed  health  care  practitioners.  It provides  hospitals,  licensing  boards  and  other 
health  care  entities  with information  relating  to the  professional  competence  and 
conduct  of physicians,  dentists,  and  other  health  care  practitioners.  It is operated  by a 
contractor  to the  Health  Resources  and  Services  Administration  (HRSA)  of the  Public 
Health  Service  (PHS). 
The  primary  users  of the  Data  Bank  are  hospitals,  which  are  required  by law to query 
the  Data  Bank  about  practitioners  at the  time  they  apply  for hospital  privileges  and  at 
least  every  two years  thereafter.  State  licensing  boards  are  permitted  to query  the 
Data  Bank,  but  are  under  no mandate  to do so.  Few  licensing  boards  have  opted  to 
query. 
Licensing  boards  receive  much  of the  information  contained  in the  Data  Bank  even 
without  querying.  They  automatically  receive  copies  of reports  to the  Data  Bank  from 
malpractice  insurers  regarding  payments  (judgments  or settlements)  made  within  their 
own States.  They  also  act as conduits  to the  Data  Bank  for hospitals  and  professional 
societies  in their  States,  receiving  reports  of adverse  actions  from  these  sources  and 
forwarding  copies  to the  Data  Bank.  In addition,  many  States  have  their  own laws 
mandating  reports  to boards  of malpractice  payments  and  hospital  discipline.  Medical 
and  dental  boards,  furthermore,  routinely  get information  on adverse  actions  against 
physicians  and  dentists  taken  by their  counterparts  in other  States  through 
clearinghouses  run  by those  boards  national  organizations.  Therefore,  information 
contained  in the  Data  Bank  that  is not  routinely  available  to State  boards  consists 
primarily  of malpractice  payments  and  hospital  disciplinary  actions  occurring  in other 
States. 
In our  inspection,  we sought  to provide  an early  assessment  of the  usefulness  and 
impact  of information  in the  Data  Bank  to hospitals  and  State  licensing  boards. 
Toward  that  end,  we based  our  data  selection  and  analysis  on matches  -- that  is, the 
occasions  on which  the  Data  Bank  provided  records  of malpractice  payments  or 
adverse  actions  to  querying  entities.  A separate  report  on hospitals  experiences  was 
based  on a sample  of 200 of the  19,122 matches  sent  to hospitals  from  the  Data  Bank 
in the  period  from  its opening  until  March  19, 1992 (see  National  Practitioner  Data 
i  Bank:  Usefulness  and  Impact  of Reports  to Hospitals,  OEI-01-90-00520,  February 
1993).  In that  same  time  period,  boards  only had  68 matches.  Because  the  number  of 
matches  was small,  the  report  on boards  experiences  assesses  the  entire  universe. 
From  the  opening  of the  Data  Bank  in September  1990 through  March  19, 1992, 13 
different  boards  submitted  59 queries  that  matched  one  or more  reports  about 
practitioners  in the  Data  Bank.  We  sent  1 questionnaire  regarding  each  query  to 
these  boards,  and  received  44 replies  from  9 boards. 
FINDINGS 
USEFULNESS TO STAZ73LICENSING  BO~Si  Most Data Bank msponw  were 
usejid to Sttzte boardk 
Measured  by both  objective  and  subjective  criteria,  the Data  Bank  appears  to be 
providing  valuable  information  to State  boards. 
Six of the  nine  responding  State  boards  query  about  all first-time  applicants  for 
licenses. 
Ten  of the  44 Data  Bank  responses  provided  information  previously  unknown 
to State  board  staffs.  All of these  responses  yielded  information  from  sources 
outside  the  States  in which  the  querying  boards  were  located. 
The  Data  Bank  has delivered  accurate  reports  to State  boards,  and  its 
timeliness  has been  improving. 
State  board  officials found  29 of 44 Data  Bank  responses  useful.  The  most 
frequently  cited  reason  for Data  Bank  reports  usefulness  was that  they 
confirmed  information  about  practitioners  that  State  board  officials  already 
knew. 
Neither  the  source  of reports  nor,  for  malpractice  reports,  the  payment  amount 
affected  the  proportion  of Data  Bank  responses  that  State  board  officials  rated 
useful. 
IMPACT  ON DECISIONS:  Data Bank repo~  never led State boardk to make  licensure 
or dimipliharydeczkionsthey wozdiinot have made without the reports, even when the 
reprts  provided ihformatzonthat State boarak did not already know. 
By the  time  of our  survey, responding  boards  had  reached  decisions  on the 
applications  or investigations  of 20 of the  44 practitioners  involved  in matches.  We 
evaluated  the  reports  impact  on those  decisions  by asking  State  boards  the  following 
question:  Would  your  decision  regarding  the  practitioner  have  been  different  if you 
had  not  queried  the  Data  Bank? 
ii  None  of the  20 decisions  would  have  been  different,  according  to State  board 
officials,  if the  boards  had  not  queried  the  Data  Bank. 
Fifteen  of the  20 Data  Bank  responses  regarding  practitioners  about  whom 
final  decisions  were  made  had  little  chance  to have  an impact  on those 
decisions.  Each  of these  responses  either  arrived  after  the  decision  was made 
or duplicated  available  information. 
Five Data  Bank  responses  arrived  before  State  boards  decisions  were  finalized 
and  contained  information  that  neither  the  practitioner  involved  nor  any other 
sources  had  provided,  but  did not  have  an impact  on State  boards  decisions. 
In four  of these  cases,  the  State  boards  granted  full approval  to the 
practitioners  requests  for licenses.  In one  case,  a board  denied  a license  for 
reasons  unrelated  to its receipt  of information  from  the  Data  Bank. 
CONCLUSION 
Most  licensing  boards  have  not  queried  the  Data  Bank.  Among  their  reasons  for not 
querying  is that  they  already  receive  much  of the  information  sent  to the  Data  Bank. 
Our  results  suggest,  however,  that  boards  may be  underestimating  the  value  of 
querying  the  Data  Bank.  Two-thirds  of the  responses  that  nine  boards  have  received 
in response  to  queries  have  been  considered  useful,  and  several  responses  have 
provided  information  that  the  boards  did not  already  have. 
Boards  might  make  the  best  use  of the  Data  Bank  by querying  in cases where 
information  from  out  of State  is needed,  because  boards  are  less likely to obtain 
information  routinely  from  out-of-State  sources  than  in-State  sources.  Boards  could 
design  targeting  strategies  with  this in mind.  For  example,  they  could  query  about  all 
practitioners  who  apply  for licenses  after  practicing  in other  States.  Or  they  could 
query  about  current  licensees  who  also maintain  licenses  in other  States. 
COMMENTS ON THE DRAFT REPORT 
We received  comments  on our  draft  report  from  the  Public  Health  Semite  (PHS)  and 
the  Assistant  Secreta~  for Management  and  Budget  (ASMB)  within  the  Department 
of Health  and  Human  Services  and  from  the  Federation  of State  Medical  Boards 
(FSMB)  and  the  American  Association  of Dental  Examiners  (AADE).  In appendix  C, 
we reproduce  each  set of comments  in full and  provide  our  responses  to them. 
A common  comment  was that  the  findings  were  difficult  to analyze  because  the 
sample  size was small.  We note  that  the  report  was not  based  on a sample,  but  was 
based  on the  universe  of matches  at the  time  of the  study.  While  we agree  that  the 
experience  is limited,  we feel  our  study provides  meaningful  insight  into  the  Data 
Banks  utility. 
... 
111   TABLE  OF  CONTENTS 
PAGE 
EXECUTIVE SUMMARY 
mODU~ON  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..*..  1 
   
mugs  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...=...  3 
                             
.  Usefulness  to State  Licensing  Boards  . . . . . . . . . . . . . . . . .  3 
                             

Impact  indecisions  . . . . . . . . . . . . . ...=.  . . . . . . . . . . . .  6 
                             
CON~USION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9 
                   
COMMENTS  ON THE  D~REPORT  . . . . . . . . . . . . . . .  .  10 
                         
APPENDICES 
A  Methodology  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...=..  A-1 
                 
B:  Summary  of Licensing  Boards  Responses  to OIGMail  Sumey  . . . . . . . . . . .  B-1 
c:  Detailed  Comments  on the  Draft  Report  and  OIG  Response  to the  Comments  C-1 
D:  Notes  . . . . . . . . . . . . . . . . . . . . . . . . . .............~-  D-l   INTRODUCTION 
PURPOSE 
The  purpose  of this study is to assess the  utility of National  Practitioner  Data  Bank 
reports  to State  licensing  boards. 
BACKGROUND 
Since  September  1, 1990, the  National  Practitioner  Data  Bank  has  received  and 
maintained  records  of malpractice  payments  and  adverse  actionsl  taken  by hospitals, 
other  health  care  entities,  State  licensing  boards,  and  professional  societies  against 
licensed  health  care  practitioners.  It provides  hospitals,  licensing  boards  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 funded  by user  fees  and  Federal  outlays.  It is 
operated  by Paramax  Systems  Corporation  (a subsidiary  of Unisys  Corporation)  under 
contract  to the  Health  Resources  and  Semites  Administration  (HRSA)  of the  Public 
Health  Semite  (PHS). 
The  primary  users  of the  Data  Bank  are  hospitals,  which are  required  by law to query 
the  Data  Bank  about  practitioners  at the  time  they  apply  for hospital  privileges  and  at 
least  every  two years  thereafter.  State  licensing  boards  are  permitted  to query  the 
Data  Bank,  but  are  under  no mandate  to do so.  Few  licensing  boards  have  opted  to 
query.2 
Licensing  boards  receive  much  of the  information  contained  in the  Data  Bank  even 
without  querying.  They  automatically  receive  copies  of reports  to the  Data  Bank  from 
malpractice  insurers  regarding  payments  (judgments  or settlements)  made  within  their 
own States.  They  act  as conduits  to the  Data  Bank  for  hospitals  and  professional 
societies  in their  States,  receiving  reports  of adverse  actions  from  these  sources  and 
forwarding  copies  to the  Data  Bank.  In addition,  many  States  have  their  own laws 
mandating  reports  to boards  of malpractice  payments  and  hospital  discipline.  Medical 
and  dental  boards,  furthermore,  routinely  get information  on adverse  actions  against 
physicians  and  dentists  taken  by their  counterparts  in other  States  through 
clearinghouses  run  by those  boards  national  organizations.  Therefore,  information 
contained  in the  Data  Bank  that  is not  routinely  available  to State  boards  consists 
primarily  of malpractice  payments  and  hospital  disciplinary  actions  occurring  in other 
States. 
In our  inspection,  we sought  to provide  an  early  assessment  of the  usefulness  and 
impact  of-information  in the  Data  Bank  to hospitals  and  State  licensing  boards. 
Toward  that  end,  we based  our  data  selection  and  analysis  on matches  -- that  is, the 
occasions  on which  the  Data  Bank  provided  records  of malpractice  payments  or 
1  adverse  actions  to querying  entities.  A separate  report  on hospitals  experiences  was 
based  on a sample  of 200 of the  19,122 matches  sent  to hospitals  from  the  Data  Bank 
in the  period  from  its opening  until March  19, 1992 (see  National  Practitioner  Data 
Bank:  Usefulness  and  Impact  of Reports  to Hospitals,  0EI-01-90-O0520,  February 
1993).  In that  same  time  period,  boards  only had  68 matches.  Because  the  number  of 
matches  was small,  the  report  on boards  experiences  assesses  the  entire  universe. 
This report  examines  why boards  who have  received  reports  elected  to query  the  Data 
Bank,  whether  they  found  the  information  they  obtained  useful,  and  what  impact  the 
information  had  on board  proceedings.  Most  of the  boards  involved  were  medical 
boards. 
METHODO~GY 
From  the  opening  of the  Data  Bank  in September  1990 through  March  19, 1992, there 
were  59 queries  from  boards  that  matched  a total  of 68 reports  about  practitioners  in 
the  Data  Bank.  Thirteen  different  agencies  submitted  these  queries:  11 medical 
boards,  1 dental  board,  and  1 umbrella  agency  representing  several  State  boards.  We 
sent  1 questionnaire  per  query  to these  boards  and  received  44 usable  replies. 
Appendix  A gives details  of our  methodology  and  provides  information  about  the 
reports,  practitioners,  and  State  licensing  boards  included  in this study. 
In this study,  the  term  report  refers  to information  about  a single malpractice 
payment  or adverse  action  that  has been  submitted  to and  stored  by the  Data  Bank. 
The  term  response  refers  to information  delivered  to a licensing  board  in response  to 
a query.  A response  may contain  one  or more  reports  about  a practitioner  named  in 
a boards  query.  Five of the  44 responses  described  in this study  contained  2 reports 
each,  for  a total  of 49 reports. 
We  conducted  our  review  in accordance  with the Interim  Standards for Inspections 
issued  by the  Presidents  Council  on Integrity  and  Efficiency. 
OTHER  REPORTS 
This  report  is one  in a series  of OIG  studies  on the  Data  Bank.  Other  studies  include: 
National  l?acti~ioner Data  Bank:  Controls Over Authorized  Agents  (OEI-12-90-
00530),  August  1991 
National  Practitioner Data  Bank:  Maipractice Reporting  Requirements  (OEI-Ol -
90-00521),  April  1992 
National  Practitioner Data  Bank:  Proj71eof Matches  (OEI-01-90-O0522),  April 
1992 
National  l?actitioner  Data Bank:  Ensuring Proper Access  by Health  Care Entities 
(OEI-12-92-00290),  August  1992 
National  Practitioner Data  Bank:  Usefulness and impact  of Reports  to Hospitals 
(OEI-01-90-00520),  February  1993 
2  FINDINGS 
USEFULNESS TO STAE13LICENSING  BO~S:  Most Data Bank reprts  were UYejid 
to State boardh 
Whether  a report  from  the  Data  Bank  is useful  to a licensing  board  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  board  in time  to be used  during  licensure  or 
disciplinary  proceedings.  Other  factors  are  purely  subjective,  such  as whether  the 
information  is relevant  to the  reported  practitioners  competency  and  professionalism. 
Measured  by both  objective  and  subjective  criteria,  the  Data  Bank  appears  to be 
movidin~  valuable  information  to State  boards. 
1  v 
  Six of the  nine  responding  State  boards  query  about  all first-time  applicants  for 
licenses. 
One  measure  of Data  Bank  reports  usefulness  is boards  persistence  in trying  to 
obtain  them.  During  the  first  18 months  of the  Data  Banks  operations,  the  odds  of 
receiving  a report  of a malpractice  payment  or adverse  action  in response  to a query 
were  slim.  The  68 matches  by State  boards  resulted  from  nearly  10,000 queries.3 
This is a match  rate  of less than  1 percent.4 
Despite  these  low odds,  six State  boards  decided  that  the  potential  of receiving 
information  as a result  of a query justified  the  six dollar  querying  fee  every  time  they 
received  an  application  for  an initial  (as opposed  to renewed)  license.  The  six are 
medical  boards  in Alaska,  Iowa, Kentucky,  Louisiana,  and  Missouri,  and  an  agency 
representing  several  boards  in Florida.  Some  of these  boards  query  under  other 
circumstances  as well.  Louisiana  and  Florida  query  about  all practitioners  who  apply 
for reactivation  or reinstatement  of their  licenses,  while  Iowa and  Florida  query  about 
certain  practitioners  who  are  under  investigation.  Alaskas  policies  resulted  in 
approximately  300 queries  through  the  Spring  of 1992; in Florida,  the  number  of 
queries  exceeded  5,000. 
The  other  boards  responding  to our  survey query  under  more  limited  circumstances. 
The  Washington  medical  board  limits  queries  to certain  practitioners  under 
investigation.  The  Nevada  medical  board  queries  about  a select  group  of license 
applicants.  The  Texas  medical  board  has  only queried  the  Data  Bank  once. 
Of the  44 queries  in our  sample,  37 were  prompted  by initial  license  applications,  3 by 
renewal  applications,  and  4 by investigations  of current  licensees. 
3    Ten  of the  44 Data  Bank  responses  provided  information  previously  unknown 
to State  board  staffs.  All of these  responses  yielded  information  from  sources 
outside  the  States  in which the  querying  boards  were  located. 
It creating  the  Data  Bank,  Congress  was trying to meet  the  national  need  to restrict 
the  ability  of incompetent  physicians  to move  from  State  to State  without  disclosure  or 
discovery  of the  physicians  previous  damaging  or incompetent  performance.5  One 
measure  of the  usefulness  of Data  Bank  reports,  therefore,  is the  extent  to which  they 
add  to boards  knowledge  by providing  information  the  boards  do not  obtain 
elsewhere.  Another  measure  is the  extent  to which  this information  pertains  to 
practitioners  who move  from  State  to State.  So far,  10 reports  to boards  in response 
to queries  have  satisfied  both  criteria.  Seven  of these  reports  involved  malpractice 
payments,  two involved  hospital  privilege  actions,  and  one  involved  a board  licensure 
action. 
Boards  do not  always receive  complete  information  from  sources  other  than  the  Data 
Bank.  Fifteen  of the  44 practitioners  involved  in Data  Bank  reports  received  by 
boards  did not  inform  the  boards  of the  payments  or adverse  actions  contained  in the 
reports.  Of the  12 Data  Bank  reports  involving  adverse  actions  taken  by State  boards, 
6 provided  information  that  boards  did not  obtain  from  either  the  Federation  of State 
Medical  Boards  (FSMB)  data  base  or the  originating  boards  themselves.  Whether  this 
communication  gap  results  from  reporting  boards  and  FSMB  failing  to provide 
requested  information  or from  querying  boards  failing  to request  information  from 
these  sources,  we cannot  say. 
  The  Data  Bank  has delivered  accurate  reports  to State  boards,  and  its 
timeliness  has been  improving. 
During  the  planning  and  early  implementation  of the  Data  Bank,  some  observers 
feared  that  erroneous  information  about  practitioners  could  be relayed  from  the  Data 
Bank  to Data  Bank  queriers.b  But  the  Data  Banks safeguards,  such  as allowing 
practitioners  to  dispute  reports  against  them,  seem  effective  in preventing  the  release 
of incorrect  reports.  Boards  had  almost  no complaints  about  the  reliability  of 
information  in Data  Bank  reports.  No board  in our  sample  responded  that  the  Data 
Bank  report  it received  was inaccurate.  (Boards  evaluated,  or had  a chance  to 
evaluate,  the  accuracy  of the  information  by comparing  it to information  they  had 
already  received  or by making  inquiries  of other  sources  after  they  received  the 
reports.  Their  judgments,  therefore,  are  good  indicators  of the  accuracy  of the 
reports.) 
In most  but  not  all cases,  responses  from  the  Data  Bank  contained  complete  histories 
of malpractice  payments  and  adverse  actions  from  September  1, 1990, through  the 
dates  of the  responses.  In 42 of the  44 cases, boards  had  no knowledge  of any 
malpractice  payments  or adverse  actions  that  should  have  been  reported  to the  Data 
Bank  but were  not  included  in the  response  to the  boards  query.  We  cannot  judge, 
however,  whether  underreporting  is a significant  problem.  Although  it seems  that  the 
4  Data  Bank  has  full information  on those  practitioners  who are  reported,  there  remains 
the  possibility  that  practitioners  who should  have  been  reported  to the  Data  Bank 
never  were. 
Timeliness  is an important  factor  in the  usefulness  of the  Data  Bank,  and  the  Data 
Bank  seems  to be  improving  in this area.  For  the  6 queries  in our  sample  submitted 
in the  Data  Banks first 6 months  of operation,  the  median  response  time  was 97 
days.8  For  the  19 queries  submitted  over  the  following  6 months,  the  median 
response  time  fell to 52 days.  During  the  final  6 months  of our  study  period,  median 
response  time  to  11 queries  was 41 days.9  (Respondents  had  not  recorded  dates  of 
submission  and/or  response  for eight  queries  in our  survey.) 
.  State  board  officials found  29 of 44 Data  Bank  responses  useful.  The  most 
frequently  cited  reason  for Data  Bank  responses  usefulness  was that  they 
confirmed  information  about  practitioners  that  State  board  officials  already 
knew. 
Measured  by board  officials assessments,  66 percent  (29 of 44) of Data  Bank 
responses  received  between  September  1, 1990, and  March  19, 1992, were  useful.  Of 
the  29 responses  they  considered  useful,  board  officials  considered  19 useful  at least  in 
part  because  they  confirmed  other  available  information.  The  next  most  frequently 
cited  reason  was that  they provided  information  unavailable  elsewhere  (eight 
responses). 
Not  all board  officials valued  responses  that  confirm  available  information.  Of the 
15 responses  considered  not  useful,  board  officials considered  13 not  useful  at least  in 
part  because  they were  duplicative. 
.  Neither  the  source  of reports  nor,  for malpractice  reports,  the  payment  amount 
affected  the  proportion  of Data  Bank  responses  that  State  board  officials  rated 
useful. 
There  were  no significant  differences  in the  percentage  of responses  judged  useful 
according  to the  incident  involved  (payment  vs. adverse  action),  amount  of malpractice 
payment,  location  of report  (in-State  vs. out-of-State),  or type  of adverse  action  (table 
l).10  These  results  are  contrary  to expectations.  Some  observers  familiar  with  the 
Data  Bank  and  with licensing  boards  believe  that  reports  of adverse  actions  would  be 
more  useful  than  reports  of malpractice  payments  and  that  reports  of large 
malpractice  payments  would  be  more  useful  than  reports  of small  ones. 
lMPACT  ON DECISIONS:  Data Bank repo~  never led State boards to make licensure 
or dkipli?wy  &chions  they wouhi not have made wzthoti the repo~,  even when the 
reprts  pmviibd  informahon that State boanik did not alreadj know. 
One  can  characterize  the  impact  on State  boards  of information  received  in response 
to Data  Bank  queries  in several  ways.  Impact  can include  giving board  staff 
5  lXB~  1 
USEIWLN=S  TO LICENS~G  BOARDs oF D_RENT  m= 
OF DATA BANK RESPONSES 
Responses 
Number  of 
Type  of respome  (see  endnote  10)  considered 
responSes  in 
useful
suney 
Incident  involved 
18 (69%) 
26 
Malpractice  payment 
11 (61%) 
18 
Adverse  action 
Amomt  of malpra~=  payment* 
5 (71%) 
7 
Less  than  $50,000 
10 (71%) 
14 
$50,000  or more 
Typ  of adveme  action 
9 (69%) 
13 
Board  licensure  action 
2 (40%) 
5 
Hospital  privileges  action 
Location  of repofl 
27 (66%) 
41 
Out-of-State 
2 (67%) 
3 
In-State 
Note:  None  of these  differences  are  significant  at the  95 percent  confidence  level. 
  The  total  amount  of five malpractice  payments  was unavailable. 
SOURCE:  OIG  Survey of State  Licensing  Boards,  Spring  1992 
  I 
confidence  that  they  have  complete  information  about  their  licensees.  It can  include
files that  could be  used  in the  future  should
adding  information  to practitioners 
But  Data  Bank  reports  can have  their  most  direct  impact  by affecting 
questions  arise. 
the  outcome  of decisions  on practitioners  who have just  applied  for  initial  or renewed
For  this reason,  we asked  boards

licenses,  or who  may be  facing  disciplinary  actions.

Would  your  decision  regarding  the  practitioner  have  been

the  folloting  question: 
different  if you had  not  queried  the  Data  Bank?

.
Because  our  measurement  of impact  focused  on the  boards  decisions,  we excluded 
any situations  involving pending  decisions  from  this analysis.  By the  time  of our 
survey, responding  boards  had  reached  decisions  on the  applications  or investigations 
of 20 of the  44 practitioners  involved  in matches. 
6  .  None  of the20decisions  would  have  been  different,  according  to Skateboard 
officials,  if the  boards  had  not  queried  the  Data  Bank. 
The  20 final  decisions  included  18 decisions  on license  applications  and  2 decisions 
following  investigations.  The  licensure  decisions  included  13 approvals,  3 rejections, 
1 restriction,  and  1 probation.  Boards  closed  both  of the  completed  investigations 
without  imposing  sanctions.  In no case  did a board  official  say the  outcome  of the 
decision  hinged  on the  response  to a Data  Bank  query. 
  Fifteen  of the  20 Data  Bank  responses  regarding  practitioners  about  whom 
final  decisions  were  made  had  little  chance  to have  an impact  on those 
decisions.  Each  of these  responses  either  arrived  after  the  decision  was made 
or duplicated  available  information. 
A variety  of reasons  explained  why it was unlikely  for Data  Bank  responses  to have 
had  an impact  on licensure  or disciplinary  decisions.  When  boards  received  responses 
after  their  decisions  had been  made,  the  responses  clearly  could  not  affect  those 
decisions.  When  boards  were  already  aware  from  other  sources  of the  information  in 
the  Data  Bank  responses,  the  responses  themselves  were  unlikely  to affect  decisions. 
Board  officials who received  confirming  information  may have  felt  more  confident 
about  decisions  they were  planning  to make,  but  they  probably  would  not  have  altered 
their  decisions  based  on duplicative  information. 
Fifteen  of the  20 responses  had  little  chance  of having  an impact  on decisions.  Four 
responses  were  received  after  the  boards  decisions.  Eleven  responses,  though 
received  by boards  before  decisions  were  made,  provided  only information  already 
, 
known  to the  boards. 
The  remaining  five responses  were  received  prior  to the  decision  and  provided 
information  unavailable  elsewhere.  These  responses  had  the  potential  for having  an 
impact  on board  decisions. 
  Five  Data  Bank  responses  arrived  before  State  boards  decisions  were  finalized 
and  contained  information  that  neither  the  practitioner  involved  nor  any other 
sources  had  provided,  but  did not  have  an impact  on State  boards  decisions. 
In four  of these  cases,  the  State  boards  granted  full approval  to the 
practitioners  requests  for licenses.  In one  case,  a board  denied  a license  for 
reasons  unrelated  to its receipt  of information  from  the  Data  Bank. 
One  practitioner  about  whom  a board  learned  of new  information  from  the  Data 
Bank  before  making  its decision  had  a long history  of adverse  incidents.  The  board 
knew  of two incidents  that  occurred  before  the  Data  Bank  opened,  and  these  incidents 
were  sufficient  grounds  to deny  the  practitioners  application  for a license.  The 
boards  decision,  therefore,  was not  affected  by the  receipt  of still more  damaging 
information  from  the  Data  Bank. 
7  All four  responses  about  practitioners  who were  ultimately  granted  licenses  contained 
single reports  of malpractice  payments.  The  payment  amounts  ranged  from  $24,000 to 
$717,366.  None  of these  practitioners  informed  the  boards  of the  payments  on their 
behalf,  and  each  Data  Bank  response  was considered  useful  by the  board  receiving  it. 
Apparently,  however,  the  boards  decided  that  neither  the  practitioners  actions  leading 
to the  malpractice  suits nor  the  practitioners  failure  to  disclose  the  payments 
warranted  an adverse  licensure  decision. 
8  CONCLUSION 
Most  licensing  boards  have  not  queried  the  Data  Bank.  Among  their  reasons  for not 
querying  is that  they  already  receive  much  of the  information  sent  to the  Data  Bank. 
Our  results  suggest,  however,  that  boards  may be  underestimating  the  value  of 
querying  the  Data  Bank.  Two-thirds  of the  responses  that  nine  boards  have  received 
to their  queries  have  been  considered  useful,  and  several  responses  have  provided 
information  that  the  boards  did not  already  have. 
Boards  might  make  the  best  use  of the  Data  Bank  by querying  in cases where 
information  from  out  of State  is needed,  because  boards  are  less likely to obtain 
information  routinely  from  out-of-State  sources  than  in-State  sources.  Boards  could 
design  targeting  strategies  with this in mind.  For  example,  they  could  query  about  all 
practitioners  who  apply  for licenses  after  practicing  in other  States.  Or  they  could 
query  about  current  licensees  who  also maintain  licenses  in other  States.  Meanwhile, 
they  might  choose  not  to query  about  practitioners  seeking  the  first  professional 
licenses  of their  careers,  as these  practitioners  are  unlikely  to have  been  reported  to 
the  Data  Bank.  A period  of experimentation  with querying  would  probably  help 
States  determine  how to make  the  most  cost-effective  use  of the  Data  Bank.  Boards 
might  wish to repeat  such experiments  periodically,  to see whether  querying  becomes 
more  fruitful  as the  Data  Bank  continues  to collect  information. 
As we noted  in the  introduction,  the  Data  Bank  provides  information  even  to those 
boards  that  choose  not  to query.  Boards  now automatically  receive  reports  of all 
malpractice  payments  and  hospital  and  professional  society  disciplinary  actions 
occurring  within  their  States.  This  function  of the  Data  Bank  has  particular 
significance  for boards  in States  without  complementary  reporting  laws. 
9  COMMENTS  ON  THE  DRAFT  REPORT 
From  within  the  Department  of Health  and  Human  Services,  we received  comments 
on our  draft  report  from  the  Public  Health  Service  (PHS)  and  the  Assistant  Secretary 
for Management  and  Budget  (ASMB).  We  also received  comments  from  the 
Federation  of State  Medical  Boards  (FSMB)  and  the  American  Association  of Dental 
Examiners  (AADE).  In appendix  C, we reproduce  these  comments  in full and  provide 
our  responses  to them. 
The  PHS  found  our  report  useful  and  had  supportive  comments.  The  PHS  felt our 
title  was somewhat  misleading.  We  have  added  some  information  in our  background 
to address  this issue. 
The  ASMB  felt  it was difficult  to evaluate  the  findings  based  on a small  sample.  We 
note  that  the  report  was not  based  on a sample,  but  was based  on the  universe  of 
matches  at the  time  of the  study.  The  ASMB  also felt  that  we should  include  three 
recommendations  in our  report.  As we explain  in appendix  C, we chose  not  to 
incorporate  ASMBS recommendations  into  our  report. 
The  FSMB  felt the  sample  size was too  small  to allow us to make  significant  findings. 
They  felt  that  it was premature  to be  doing  a study  of this sort.  As noted  above,  the 
report  was based  not  on a sample  of matches,  but  on the  universe  of matches  at the 
time  of the  study.  While  we agree  that  the  experience  is limited,  we feel  our  study 
provides  meaningful  insight  into  the  Data  Banks  utility. 
The  AADE  was also concerned  about  the  size of the  sample,  particularly  since  only 
one  dental  board  was represented.  They  suggested  that  the  report  distinguish  between 
medical  boards  and  dental  boards.  We  have  included  more  information  in the 
introduction  to clarify that  most  of the  experience  we base  our  conclusions  on is from 
State  medical  boards. 
10  APPENDIX  A 
METHODOLOGY 
We  collected  the  data  presented  in this report  through  a mail  survey  of State  licensing 
boards  conducted  from  February  to July  1992.  We  surveyed  the  universe  of all 
59 Data  Bank  queries  from  licensing  boards  between  September  1, 1990, and  March 
19, 1992, that  resulted  in matches.  A match  is a pairing  of a report  and  a query  to the 
Data  Bank  that  name  the  same  practitioner.  The  59 queries  matched  a total  of 68 
reports  in the  Data  Bank.  We  requested  and  received  from  Paramax  Systems 
Corporation  a computer  file containing  records  of all queries  and  reports  received  by 
the  Data  Bank  that  identified  the  same  practitioner.  We restructured  and  analyzed 
the  data  using  Version  6.04 of the  SAS System for Personal  Computers. 
By April  1992, we had  mailed  a questionnaire  about  each  query  to the  board  involved. 
Thirteen  boards  received  these  questionnaires.  Table  A shows the  response  rate  for 
each  board.  Analysis  of nonrespondents  showed  no biases  in favor  of types  of reports 
(adverse  actions  VS.malpractice  payments)  or dollar  values  of malpractice  payments. 
Appendix  B shows the  questionnaire  and  simple  frequencies  of the  responses. 
Five  of the  respondents  queries  matched  two reports  in the  Data  Bank.  Therefore, 
our  44 returned  surveys corresponded  to 49 individual  matches. 
With  the  exception  of one  dentist,  all practitioners  named  in the  44 returned  surveys 
were  physicians.  Eighteen  queries  matched  reports  of adverse  actions  and  26 matched 
reports  of malpractice  payments.  The  adverse  actions  consisted  of 14 board 
disciplinary  actions  and  6 hospital  privilege  actions  (2 queries  matched  2 adverse 
actions  each). 
A-1  -1 
Number of  Number of  Number of 
Licensing Board  Queries  RepOr@  Responses to 
OIG 
Resulting in  Matchd  Sumq 
Match= 
5  5  5 
hska  Board of Mediul  Examiners 
0 
1  1 
Jaska Board of Dental Examiners 
0 
1 
1 
bnnecticut Divisionof Mediml Quality 
Msurance 
24  26  17 
~oridaDepartmentof Professional 
{egulation 
6  8  3 
owa Board of Medid  Examiners 
1  1 
1 
Centuc& Board of MediMl L@nsure 
11  10* 
10 
Louisiana Board of Mediml Examiners 
Q 5 
5  0 
Missouri Board of Registration for the 
Healing ~ts 
1  1  1 
Nevada Board of Mediml Examiners 
2 3  0 
New Jersey Board of Mediml Examiners 
1 0 
1 1 
Pennsylvania Board of Medicine 
1 1  1 
Texas Board of Mediml Examiners 
1  1 
1
Washington Mediml Disciplinary Board 
59 68  44 
Total 
*Among the queries  for which we received  replies  to our survey, three from the  Missouri
and one  from the Louisiana  Board matched  two Data 
Board,  one  from the Florida  Board, 
Bank  reports.  Therefore,  the  total  number  of reports  matched  by queries  in our  sample  is 
49 rather  than  44. 
I 
A-2
 APPENDIX  B

sUMMARY  OF LKENSmG  BOWS  RESPONSESTO OIG MAIL SURWY 
SERW-
U.S.  D=MW~  OF  =m  AND  ~ 
USE  AND  UTILITY  OF THE 
NATIONL  PRACTITIONER  DATA  BANK 
NOTE:  The first23 questionsinthissurveyconcernthecaseofDoctor& whoseidentityisgivenonthe 
Pleaseconfineyourresponsesto yourknowledgeofthat particularcase. 
attachedidentifimtionsheet. 
BASIC FACTS AND  CHRONOLOGY 
1 
1  What  is Doctor  As specialty?  18 difierent spectilhm  repraented 
2 
On what  date  did you request  information  about  Doctor 
//
 
A from  the  National  Practitioner  Data  Bank? 
3 
On what  date  did you receive  a response  from  the  Data 
I1f I
Bank? 
what  prompted  you  to request  information  about  Doctor  A from  the  A 
National  Practitioner  Data  Bank? 
37  (a)  Initial license  application  (Go to Question  5) 
3  (b) Renewal  of license  (Go to Question  6) 
4C  ()  Inquiry  or  investigation  (Go  to Question  9) 
o  (d)  Other  (Explain: 
) (Go  to Question  13) 
5 
(2hswer  if you  answered  (a) to Question  4) 
5	 //
On what  date  did Doctor  A file an initial  license  ~s~tr 
a~plication?  Question T)
AA 
6 
6  (Answer  if you  answered  (b) to Question  4)  // 
On what  date  did Doctor  A filea renewallicense     
II 
application? 
B-1
 7 
7  (Answer  if you  answered  (a) or (b) to Question  4)  // 
on  what  date  did the  State  board  make  its decision  ,_  _   
about  Doctor  As licensure  application  or renewal? 
8 
(Answer  ~ you  answered  (a) or (b) to Question  4, then 
skip to Question  13) 
on Doctor  As license? 
What  was the  decision 
reached  yet 
22  (a) No decision 
13	 (b) License  application  approved  or renewed 
without  restrictions 
3  (c) License  application  rejected 
1  (d) Restrictions  placed  on license 
1  (e)  Provisional  or probationary  approval  given 
0  (f) other  (Explain: 
) 
--4 
9 
(Answer  if you  answered  (c) to Question  4) 
9  . //  

On what  date  did the  State  board  initiate  an

investigation  on Doctor  A?

10 
(W.swer  if you  answered  (c) to Question  4) 
10  //_
On what  date  did the  State  board  close its investigation  _ 
on Doctor  A?  (Write OPEN if the case is still open.) 
B-2
 11  (Answer  if you  answered  (c) to Question  4) 
What  prompted  the  investigation? 
O  (a)  Consumer  complaint 
O  (b)  Conviction  in a criminal  case 
1	 (c) Clinical  privileges  action  by a hospital,  HMO, 
other  health  care  organization 
o  (d) Peer  retiew  organization  or Medicaid  action 
O  (e)  Malpractice  claim  or payment 
3	 (f)  Other  (Specify:  iquiry  from another State 
board  sumender of license in another State, repoti 
from FSMB) 
12 
2	 (Answer  if you  answered  (c) to Question  4) 
What  was the  result  of the  State  boards  investigation? 
2  (a)  No decision  reached  yet 
2  (b)  Case  closed  without  action 
O  (c)  License  revocation 
O  (d)  License  suspension 
O  (e)  License  probation 
O  (f) Other  (Specify~ 
) 
B-3
 AVAIUBILIW  AND  ACCURACY  OF  INFORMATION 
, 
YES: 34  13 
I  from  sources  other  than  the  Data 
Were  you aware,  NO:  10 
Bank,  of the  incident  mentioned  in the  response  from  (If no, skip to 
the  Data  Bank  and  the  subsequent  disciplinary  action  or  Question  15) 
(Answer  NOif the only 
malpractice  payment? 
information  you  received from  other sources conskted  of 
those sources repotis to the Data Bank.) 
From  which  of the  following  sources  were  you aware  of the  incident  1A 
and/or  the  subsequent  disciplina~  action  or payment? 
Aware  OX 
Aware  of  Action/ 
payment 
kcident 
Source 
YES:29  YES:26  @ 
Doctor  A (self-report) 
a,b 
q 
YEs:  7  YEs:  5 
C,d  Federation  of State  Medical  Boards 
yl?s:  12  YES: 8  e
e,f  Licensing  board  in  another  state 
YEs:o  XEs:o  g: 
g,h  Malpractice  insurer  in your  state 
YES:o  ylfzos: 
i~  Malpractice  insurer  in another  state 
yzs:1  YEs:1  k 
Hospital  in your  state 
k,l 
YEs:o  m,n 
YES:2 
m,n  Hospital  in another  state 
YES:o  O,p 
Es: o 
O,p  Professional  society  in your  state 
ym: o  q,r 
YEs:o 
q,r  Professional  society  in another  state 
YES:1  YES:1  S,( 
S,t  Other  source  in your  state 
(IF  YES,  SPECIFY: 
)
/ 
1 
XEs:1  yjqy:  u; 
U,v  Other  source  in  another  state 
(IF YES,  SPECIFY: 
\ 
~) 
H!zS5:  15 
15  Was  the  information  you  received  in the  Data  Bank  NO: 37 
response  inconsistent  in any way with the  information  MISSING:  2 
received  from  any of the  above  sources? 
)
~ 
(1F YES,  WHICH  SOURCES? 
M!?S:16  ~G 
16  Did you make  additional  inquiries  to confirm  the  NO: 26 
accuracy  of the  Data  Bank  report  or to obtain  more 
MISSING:  2 
detailed  information  on its content  (for  example,  from 
(If no, skip to 
reporting  hospitals  or insurers)?  Question 18) 
u 
1 
13-4  1 
YES:  16  17 
17  (Skip  if you  answered NO  to Question  16)  NO:  O 
Did you find the  information  in the  Data  Bank  07HER 1 
response  to be  accurate? 
(1F NO,  E~LAIN:  One board was still waitig  for 
infonnatin  in respowe  to i~ follow-up  @u@.) 
YES: 15  18 
18  Were  you  aware  of any incidents,  disciplinary  actions,  or  NO:28 
malpractice  payments  involving Doctor  A that  were  ~  MISSING:  1 
contained  in the  response  from  the  Data  Bank?  (If no, skip to 
II  Ouestion22) 
MISSING: 
(Skip  if you  answered NO  to Question  18)  ONE:  5 
How  many  disciplinary  actions  and  malpractice

payments  were  you  aware  of that  were  @  contained  in  7x7WVEOE: : 4  2

the  response  from  the  Data  Bank?  FOUR  2

NINE:  1 
NONE:  13  zO 
(Skip  if you  answered NO  to Questiotl  18) 
How  many  of these  disciplinary  actions  and  malpractice  ~0:  2 
payments  occurred  after  September  1, 1990? 
21 
(Stip  if you  answered NO  to Question  18) 
Which  of the  following  sources  provided  information  about  incidents, 
or payments  that  were  I@  contained  in the 
disciplinary  actions, 
response  from  the  Data  Bank?
A  ES:  14
Doctor  A  (self-report)
a 
ylzs3: 

Federation  of State  Medical  Boards 
b 
YES: 6 
Licensing  board  in another  state 
c 
YEs:o  d 
Malpractice  insurer  in your  state 
d 
YES:o  e 
Malpractice  insurer  in another  state 
e 
YES:o  f 
Hospital  in your  state 
f 
YEs:2  g
Hospital  in another  state 
g 
YEs:o  h 
Professional  society  in your  state 
h 
ylzso:   i 
Professional  society  in another  state 
i 
YEs:o  j
Other  source  in your  state
j 
(IF YES,  SPECIFY: 
) 
YES:o

Other  source  in  another  state
k 
(IF YES,  SPECIFY: 
) 
B-5
 UTILIW  OF  INFORMATION 
YES: 29  22 
Overall,  do you believe  the  information  about  Doctor  A

NO:  15 
contained  in the  response  from  the  Data  Bank  was

useful  to you?

IF YES,  WHY?  (Check  all that app~)

8  (a)  Information  was not  available  elsewhere 
19  (b)  Information  confirmed  other  reports  that 
were  available  elsewhere 
3  (c) Information  helped  us to judge  Doctor  As 
competency 
3  (d)  Information  helped  us to judge  Doctor  As 
professionalism 
6  (e)  Other  (Explain: 
) 
IF NO,  WHY  NOT?  (Cheek  all that app~) 
13  (f)  Information  was available  elsewhere 
0  (g) Information  was not  accurate 
1	 (h)  Information  did not  help  us to judge  Doctor 
As competency  or professionalism 
4  fi)  Information  was  not  provided  in  a timely
- \/ 
manner 
0  (j) Other  (Explain: 
)
) 
YEs:  o  23 
23	 Would  the  decision  regarding  Doctor  As license  or  NO: 36 
investigation  have  been  different  if you had  @  queried  oXHER 1 
the  Data  Bank? 
(IF YES,  EXPLAIN:  NOTE:  Some  boards that had not  MISSING:  7 
yet reached final deckions  nevetihelms answered that their 
wouki  not have been different had thq  not 
dechions 
queried the Data Bank) 
B-6
 NOTE:  The  remaining  questions  do  not  concern the specific case of Doctor  ~  but  rather  your 
general experience with and attitudes about the Data Bank. 
GENERAL  QUESTIONS  ON THE 
NATIONAL  PRACTITIONER  DATA BANK 
24  How,  if at  all, have  the  other  parts  of your  licensing  and  investigation  ~ 
procedures  been  affected  by the  availability  of the  Data  Bank? 
Five boarb  cited no ejJec@, generally.  7%ree boarck said that querying 
the Data Bank slowed down the licensure process.  mO  boarh  noted 
that the Data Bank provided the boards with another usefi.dsource of 
hlfomlatlon 
2s  Under  what  circumstances  have  you queried  the  National  Practitioner  X 
Data  Bank?  (Check  all that app~.) 
~  (a)  All initial  license  applications 
~  (b)  All license  renewal  applications 
&  (c) All complaints  and  referrals 
_O_(d)  All investigations  and  inquiries 
~  (e)  Other  (Speci@  All reachvatiom  and reinstatements: 2 boards 
Some investigations and inquirim: 2 boards.  Some lice~~e applications:1 
board  Only one query ever: 1 board) 
26  What  is the  total  number  of queries  you have  made  to  Range:  26 
the  Data  Bank  to date?  1- 5,000+ 
27  Please  rank  the  following  four  types  of information  maintained  in the  27 
Data  Bank  in terms  of their  usefulness  to you--in  practice  or in 
theory--in  the  licensing  and  investigation  process.  (Let  1 =  most 
useful  and  4 =  least  use ful.)  NOTE:  Means  were calculated  mung one 
score per board  not one score per response. 
a  Hospital  disciplinary  actions/privilege  restrictions  MU:  1.5  a 
b  Licensing  board  actions  MM:  21  b 
c  Malpractice  payments  AfEAIW 2.8  c 
d  Professional  society  disciplinary  actions  Mm:  3.1  d 
B  Is there  any type  of information  currently  maintained  by the  Data  z 
Bank  that  you believe  would  ~  be useful  to you under  ~ 
circumstances?  If so, please  explain. 
All boards either answered no or did not respond 
B-7  29	 What  kind  of information  @  currently  maintained  by the  Data  Bank  29 
would  be  useful  to you? 
One board suggested other States deniak  of license applications, one 
suggested criminal recordr, and one suggmted tiformation  regarding 
incidenfi that occumed before the Data Bank opened  Other boards 
answered none or did not respond 
30	 Please  list any additional  comments  and  suggestions  you have  about  so 
the  National  Practitioner  Data  Bank,  especially  those  that  pertain  to 
its usefulness  to State  licensing  boards. 
One board suggested that applicants be respowble for que@g  the Data 
Bank and that responsm be sent automatical~  to the boaruk.  One board 
asked that the reportingprocess be simplified  One board commented 
that ~heData Banks respowe  time was too slow.  One board noted t~t 
it rarely queried because information in the Data Bank generally 
duplicated what the board already knew.  One board said that because 
the tifotmation  was duplicative, the six dollar que@ng  fee  was too higk 
One board predicted that the Data Bank wouki become  more we~  to 
boarh  if and when it collecti  information about practitioner  other than 
physJciansand dentkts.  Three boards dti  not respond 
B-8

  APPENDIX  C 
DETAILED  COMMENTS  ON THE  DRAFT  REPORT  AND 
OIG  RESPONSE  TO  THE  COMMENTS 
In  this  appendix,  we  present  in full  the  comments  on  the  draft  report  offered  by the 
Public  Health  Semite  (PHS),  the  Assistant  Secretary  for  Management  and  Budget 
(ASMB),  the Federation  of State  Medical  Boards  (FSMB),  and the American  Association 
of Dental  Examiners  (AADE).  We also present  our  response  to each  set of comments. 
c-1  - .
PublicHealthServi~ 
DWWT~T  OF HEAL~  & HUM  SERWCES 
Memorandum 
  IJEC241992 
SecretarY  for  Health  Managaent  Operations 
Deputy  Assistant 
Office  of  Inspector  General (OIG)  Draft  Report  National
Usefulness  of  Reports  to  State
Practitioner  Data  Bank: 
, 
Licensing  Boardsr  0EI-01-90-O0523 
0s 
General  for  Evaluation  and  Inspections, 
Deputy  Inspector 
on  the  subject
AttaChed  are  the  Public  Health  e~ice  coment~ontributes  to 
draft  OIG  report.  we  bel~eve  that  the  repo. rt on  the  =~~ly  Data
the  growhg  positive  evaluative  litaratlar~ 
7* 
Anthony  L.  lt   
Attactient 
c-2  PUBLIC  HEALTH  SERVICE  fPHS~  COMMENTS  ON  THE  OFFICE  OF 
INSPECTOR  GENERAL  (OIG)  DIUU?T  REPORT  NATIONm 
PRACTITIONER  DATA  BANK:  USEFULNESS  AND  IMPACT 
OF  REPORTS  TO  STATE  LICENSING  BOARDS 
The  OIG  performed  this  study  to  assess  the  uti-li.ty  of  National 
Practitioner  Data  Bank  (NPDB)  reports  to  State  li-censi.ng 
boards.  In  this  study,  OIG  focussed  on  the  experiences  of  a 
small  group  of  State  boards  who  queried  about  practitioners 
who  had  in  fact  been  reported  to  the  NPDB.  OIG  sought  to 
determine  why  these  boards  elected  to  query  the  NPDB,  whether 
they  found  the  information  the  NPDB provided  useful,  anti  what 
impact  the  information  had  on  the  board  proceedings. 
The  OIG  found  that  most  NPDB  responses  were  useful  to  State 
kmar~s;  however  ~  the  rqoxts  never  led  the  boards  to  make 
licensure  or  disciplinary  decisions  that  they  would  not  have 
made  even  without  the  reports.  OIG  concludes  that  boards 
might  xnake  the  best  use  of  NPDB  reports  by  querying  in  cases 
where  information  from  out-of-state  is  needed. 
We  believe  that  the  OIG  report  represents  a  contribution  to 
the  growing  positive  evaluative  literature  on  the  early 
NPDB.  However,  some  readers  of  the  report  may  be  misled  by 
the  reports  subtitle  which  suggests  that  the  studys  findings 
are  generalizable  to  all  State  licensing  boards.  We  suggest 
that  the  report  emphasize  that  query  matches  involving  only 
13  State  boards  were  the  basis  of  the  study. 
Technical  Comment 
There  is  a  minor  omission  in  the  first  sentence  of  the  first 
full  paragraph  on  Page  5.  The  introducto~  clause  of  that 
sentence  should  read:  Timeliness  is  an  important  factor  in 
the  usefulness  of  the  Data  Bank  . ... 
c-3  OIG  RESPONSE  TO  PHS  COMMENTS 
The PHS suggested  that  the title of the report  might mislead  readers  to believe  the report 
was  generalizable  to  all  State  licensing  boards  when  in  fact  it  was  based  on  the 
experiences  of  only  13 boards.  Because  our  report  is based  on  a  sumey  of  all  State 
licensing  boards  that  had  had  matches  as of March  1992 and  thus  represents  fully this 
universe,  we have  not  changed  the  title.  We  have,  however,  added  information  in the 
background  section  to emphasize  that  this is an early  look  at the  Data  Bank. 
c-4  4+,? @vms  ~,f  - of the SecretW 
:.  DEPARTMENT OF HEALTH&  HUMAN SERVICES 
: 
2
% ~
%  Washington,  D.C.  20201 
%>v,la
NW  I!3IWL

Bryan  B.  Mitchell 
MEMOWD~  TO:	
Principal  Deputy  Inspector  General  ~ 
FROM    Arnold  R.  Tompkins 
~sm~anw 
Assistant  Secrets 
h 
llNational  practitioner  Data 
SUBJECT    OIG  Draft  Report: 
 
Bank:  Usefulness  and  Impact  of
 Reports  to  State

It  OE1-ol-gO-00523 
Licensing  Boards, 
Thank  you  for  the  opportunity  to  review  your  draft  report, 
il??atlonal  practitioner  i)ata  i3anlc:  Usefulness  and  Impact  of
Overall,  we  have  found  the 
Reports  to  State  Licensing  Boards. 
i.nformati.on  provided  in  your  report  very  use~ul,  although  ~t  WaS 
somewhat  difficult  evaluating  the  findings  of  the  report  given
We  do  agree  that  those  who  were  surveyed  found 
the  small  sample. 
the  majority  of  Data  Bank  Reports  to  be  useful. 
We  think  that  the  Data  Bank  provides a	 very  valuable  service  and
to  increase  the  usefulness  of  these
suggest  that  PHS  find  ways 
reports  to  State  Boards. 
comments  and  recommendations
Therefore,  we  provide  the  following 
for  your  consideration. 
about  this  response,  please  have 
If  your  staff  have  any  questions 
them  call  Neil  J.  Sti.llman,  Deputy  Assistant  SecretarY  for 
Information  Resources  Management,  at  690-6162,  or  Joanne  Amato, 
Office  of  Information  Resources  Management,  at  690-8358. 
At~~Chment 
C-5
 OIG  Draft  Re~ort 
tNational  Practitioner  Data  Bank: 
Usefulness  and  Im~act  of  Reports  to  State  Licensincf  Boardss 
We  have  found  the  information  provided  by  your  report  accurate 
and  useful,  although  it  was  somewhat  difficult  to  evaluate  the 
findings  of  the  report  given  the  small  sample.  We  do  agree  that 
most  Data  Bank  reports  were  useful  to  State  Boards  included  in 
your  survey. 
Based  on  information  contained  in  the  report,  we  agree  that 
Boards  might  make  the  best  use  of  the  Data  Bank  by  querying  h 
cases  where  information  from  out-of-State  i.s  needed,  since  the 
boards  are  less  likely  to  obtain  this  information  routinely.  We 
also  agree  that  timeliness  is  an  important  factor  in  determining 
the  usefulne~~  GZ  reports,  although  it  does  not  seem  to  be  as 
significant  a  problem  for  State  Licensing  Boards  as  for 
hospitals.  We  also  believe  that  these  reports,  in  general,  Could 
be  more  useful  i.f  Boards  were  required  to  qubry  the  Data  Bank  h 
certain  instances.  Given  this,  we  suggest  that  you  provide 
recommendations  to  PHS  as  part  of  your  report  and  offer  the 
following: 
PHS  is  currently  in  the  process  of  determining  priorities 
and  strategies  for  procuring  its  second  contract  for 
administration  of  the  Data  Bank.  We  suggest  that  PHS  work 
with  Data  Bank  customers  i.n  defining  addi.ti.onal  data  needs 
(possibly  focusing  on  out-of-State  information)  that  will 
increase  the.  usefulness  of  these  reports,  as  part  of  the  new 
system  design  requirements. 
Likewise,  we  strongly  recommend  that  PHS  make  improving 
query  response  time  a  high  priority.  It  is  our  opinion  that 
the  new  system  design  should  support  a  virtually  paperless 
environment  and  provide  interactive  access  to  the  user.  We 
believe  that  this  type  of  design  will  not  only  cut  down  on 
errors  significantly,  but  can  also  reduce  costs  and  increase 
the  timeliness  of  responses  to  our  customers. 
We  suggest  that  PHS  seek  legislative  authority  requiring 
State  Licensing  Boards  to  query  the  Data  Bank  for  first-time 
license  requests  and  for  applicants  who  have  practiced 
in  another  State. 
C-6  OIG  RESPONSE  TO  ASMB  COMMENTS 
Although  we agree  with the general  thrust  and many of the specifics of ASMBS suggested 
recommendations,  we have not incorporated  them into our report.  We believe  that PHSS 
work  with  the  Data  Bank  Executive  Committee  and  regular  communications  with  user 
groups  constitute  sufficient  efforts  to identify  additional  data  needs.  (Furthermore,  the 
State  licensing boards  we surveyed were given the opportunity  to identi~  useful additional 
data,  but  no type  of data  was identified  more  than  once.)  We believe  that  PHS  should 
make  improving  response  time  a high priority;  we note  that  we made  a recommendation 
to  this  effect  in  our  report  entitled  National  Practitioner  Data  Bank:  Usefulness  and 
Impact  of Reports  to Hospitals  (OEI-01-90-00520).  Finally, while we feel that  our report 
shows that  the  Data  Bank  is potentially  a useful source  of information  for State  licensing 
boards,  particularly  about  applicants  who have practiced  in another  State,  we do not feel 
our evidence  warrants  a recommendation  that  PHS  propose  legislation  requiring  boards 
to query.  We feel that  since our report  is based  on early evidence  from very few boards, 
we should  not make  anything  more  than  suggestions  about  whether  boards  should  query 
and when  they  should  query. 
c-7  2 February  1993 
David  R. Veroff 
Project  Leader 
THE FEDERATION  OF  Office  of Inspector  General 
SZ4TE MEDICAL  BOARDS  Office  of Evaluation  and  Inspections 
OF THE UNITED SZAm  INC 
Region  1 
John  F. Kennedy  Federal  Building 
6000 WESTERN  PLACE 
Bosto~  MA  02203 
SUITE 707 
FORT WORTH, TEXAS 
76107-4618 
Dear  Mr Veroff 
817735-8445 
FAX 817738-6629 
I appreciate  the  opportunity  to comment  on the  OIGS  draft  report  titled 
National  Practitioner  Data  Bank:  Usefulness  and  Impact  of Reports  to 
OFFICERS 
State  Licensing  Boards.  I have  also reviewed  the  accompanying  report 
PRESIDENT 
MELVINE. SIGEL,  MD  related  to hospitals  but  will not  comment  directly  on that,  save to suggest 
2211 PARK  AVENUE  SOUTH 
MINNEAPOLIS,  MN 55404  that  it appears  a more  useful  effort. 
PRESIDENT  ELE~ 
HORMOZ  RASSEKH,  MD 
201 RIDGE  STREET,  #lOS 
COUNCIL  BLUFFS  1A 51503  To  begin,  I agree  with  the  basic  thrust  of the  report  related  to the  state 
VICE  PRESIDENT  boards:  that  the  NPDB  can be  a valuable  tool  for any entity  that  must 
GERALD  J. BECHAMPS,  MD 
WP. ION.C HBOEXW E2R6,9 8  VA 22601  review  physician  credentials  and  should  be  as widely  used  as possible.  At 
TREASURER  the  same  time,  I recognize,  as you do, the  limitations  of the  bank 
SUSAN  M. SPAULDING 
P. O. BOX 222  stemming  from  its shallow  reservoir  of data.  As you remark  this will 
MONTPELIER,  VT 05601 
DIRECTORS  change  as years  pass. You  are  also correct  in pointing  out  the  banks  value 
BARBARA  S. SCHNEIDMAN,  MD  as a potential  resource  for research  in the  liability  area.  Clearly,  and  for 
140 LAKESIDE  AVE.,  #200 
SEATTLE.  WA 98122  obvious  reasons,  its role  in relation  to state  board  actions  is redundant,  but 
LEROY  B. BUCKLER,  MD  that  does  not  detract  from  its value  as a source  of information  for boards 
640 SOUTH  STATE SREET 
DOVER,  DE 19901 
on privileging  and  liability  actions  taken  in other  states. 
RENDEL  L. LEVONIAN,  MD 
P. O. BOX 756 
PICO  RIVERA,  CA 90660 
However,  as I noted  in my comments  to the  Executive  Committee  in 
RAYMOND  J. ALBE~ 
7505 BUNKERHILL  RD. 
AMANDA,  OH 43102  December,  the  data  presented  in this report  are  so sparse  that  their  use  to 
JOHN  T. HINTON,  DO  demonstrate  any point  reliably  is simply  not  tenable  by any reasonable 
P.O. BOX  338 
COLLEGE  CORNER,  OH 4S003  standard.  The  study was certainly  premature  and  its conclusions,  because 
ROBERT  1?. PORTER,  MD 
ONE  MEDICAL  CENTER  DRIVE  of that,  are  of doubtful  utility. The  most  significant  points  deriving  from 
LEBANON,  NH 03756 
the  data,  in fact,  are  that  few state  boards  are  yet  (as of the  date  of the 
STEPHEN  P. KELLEY.  JD 
16CKITCF TOWER  study)  using  the  NPDB  and  that  the  banks  response  time  must  be 
MINNEAPOLIS,  MN  5S402 
JAMES  E. WEST,  MD  improved  for it to be  of significant  value  in decision  making.  Beyond  that, 
411-D EASI  9TH  ST. 
ANN1SIT3N,  AL 36201  the  data  camot  go. And  simple  common  sense  has  told  us both  those 
SPT.EOP.H BEON X 1S2. 2S4E5E LING,  JD  things  for some  time. 
COLUMBIA.SC 2921I 
I suggest  that  a study of this type might  better  be  done  after  more 
extensive  NPDB  experience  has accumulated,  and  that  this original  effort 
JAMES  R, WINN,  MD 
EXECUTIVE  VICE  PRESIDENT 
DALE  G BREADEN 
ASSOCIATE  EXECUTIVE 
VICE  PRESIDENT 
1. KATHRYN  HILL,  MEd 
ASSI~ANT  EXECUTIVE  C-8 
VICE  PRESIDENT  Page  2 
2 February  1993 
David  R. Veroff 
be put  aside.  If, indeed,  the  purpose  of the  report,  as stated  at its beginning,  is to study the 
utility  of NPDB  reports  to state  licensing  boards,  it fails for being  too  small  a sample  taken 
too  soon. 
Sincerely 
7,7  J* 
James  R. Wi~  MD 
Executive  Vice  President 
JRW:lV 
c-9  OIG  RESPONSE  TO  FSMB  COMMENTS 
We  agree  that  State  licensing  boards  experiences  with  Data  Bank  reports  are  limited. 
However,  we feel that  it is worthwhile  to assess their  experiences  thus far to provide  early 
insights on an important  function  of the Data  Bank.  We note  that  the report  is based  on 
a sumey  of ~  boards  that  had  matches  at the  time  of the  study.  As such, it represents 
the  universe  of boards  experiences  with reports  from  the  Data  Bank.  Because  boards 
experiences  have been  limited, we do not recommend  mandated  action by PHS, Congress, 
or boards,  but  instead  suggest that  boards  consider  certain  actions  in light of their  needs 
(we note  that  others  felt our  results  indicated  the  need  for mandates).  The  FSMB  also 
contends  that  the  most  significant  points  deriving  from  the  data  were  self-evident.  We 
disagree;  we believe  the  information  on usefulness  and  impact  to be  new  and  valuable 
information  particularly  at  this  early  juncture.  We  do  agree,  however,  that  our 
examination  comes  early  in the  history  of the  Data  Bank.  We  have  added  text  in the 
introduction  to emphasize  the  fact  that  this inquiry  was intended  to be  an  early  look  at 
how State  licensing  boards  have  used and perceived  the usefulness  of Data  Bank  reports. 
In the  introduction,  we also more  clearly  describe  the  scope  of the  report. 
c-lo  AMERICAN  ASSOCWTION OF DENTAL EXAMINERS 
211 E. Chicago Ave., Suite 644, Chicago, IL 60611  (312) 440-7464 
January  18,  1993 
Mr.  David  Verof  f

FRBsrDm  Project  Leader

Department  of  Health  and  Human  Services

Dr. Wayne J. Barnes  Office  of  Inspector  General

2928  Hamilton Boulevard  Office  of  Evaluation  and  Inspections

Sioux City, IA  51104 
JFK  Bldg.

(7 12) 255-7607 
Room  1407

pRmmlNT-EUm  Boston,  MA  02203

m. Joel F. Glovcr  *

Dear  David:

3605 Grant Drive 
Rcno, NV 89509 
(7o2) 825-2417  Thank  you  for  giving  the  American  Association  of 
Dental  Examiners  the  opportunity  to  comment  on  the 
FIRST VICE~~W  OIGS  October  1992  draft  report  National 
Practitioner  Data  Bank:  Usefulness  and  Impact  of 
Dr. Lillian H. BachnuMI  Most  of  the 
Reports  to  State  Licensing  Boards. 
30 East 60ch Street 
New York, NY 10022  AADE  comments  were  transmitted  to  you  by  telephone 
(212) 755-0125  or  during  the  National  Practitioner  Data  Bank 
Executive  Committee  Meeting,  December  14,  1992. 
SECONDVICE-PRWDW 
The  report  stated,  From  the  opening  of  the  Data 
Dr. Ken C. Crawley 
440 Broad S1.  Bank  in  September  1990  through  March  19,  1992, 
Columbit%  MS39429  there  were  59  queries  from  boards  that  matched  a 
(6ol) 736-1761  total  of  68  reports  about  practitioners  in  the 
Data  Bank.  Thirteen  different  agencies  submitted 
THIRD Vlm-mmmm 
these  queries:  11  medical  board%  1  dental  board~ 
Dr. Harry R. Dominen  and  1  umbrella  agency  representing  several  state 
2860 Piedmont Avenue  boards.  In  my  opinion,  this  is  an  extremely 
Duluth, MN 55811 
small  sample  from  which  to  draw  any  conclusions 
(218) 722-0823 
especially  regarding  usefulness  of  the  NPDB  for 
the  dental  boards.  Also,  i.t  is  suggested  that 
IMMEDIATE PAST PRBSIDENT 
comments  distinguish  between  medical  and  dental 
m. Robert  T. Ferris  boards  in  the  report. 
475 Maitland Avenue 
Ahamont.eSprings, FL 32701  In  addition,  I  agree  with  comments  made  at  the 
(4o7) 831-1747 
NPDB  Executive  Committee  Meeting  by  Dr.  Jim  Wynn, 
IMKUTIVE  DIR.IKXOR  Federation  of  State  Medical  Boards  Executive 
Director,  that  an  important  question  was  missed  in 
Ms. Molly Nadler  this  study  -- why  state  boards  do  not  query  the 
211 E. Chicago Avenue 
NPDB .  Possibly  another  study  could  be  done  when 
Suite 844 
Chicago, ~  60611  more  boards  have  queried  that  would  address  the 
(312) 440-7464  cost  versus  benefit  ratio  to  the  boards. 
EDITOR 
Again,  thank  you  for  allowing  the  AADE  to  comment. 
m. Kathleen Kelly 
Sincerely, 
44 E. Mifflin Sk&t 
Suite 204 
Madiso% WI 53703 
4 
(608) 256-049  Molly  Nadler 
Executive  Director 
cc :  Members,  Executive  Council 
C-II  OIG  RESPONSE  TO  AADE  COMMENTS 
We agree  that  it is difficult  to judge  the  usefulness  of the  information  in the  Data  Bank 
to State  dental  boards  based  on the  experience  of one  board  with one  match.  We note, 
however,  that  we  did  not  draw  a  sample  of  the  matches,  but  instead  looked  at  the 
universe  of matches.  Our conclusions  are based  on all of the experiences  boards  had had 
with reports  at the time  of the study.  Therefore,  while we have  added  information  in our 
background  that  emphasizes  that  most  of the  experiences  with reports  have been  comes 
from  medical  boards,  we have  not  made  changes  to findings  or to the  conclusion. 
The  AADE  notes  that  we did not  address  an  important  issue in our  study  -- why State 
boards  frequently  do not  query  the  Data  Bank.  We  agree  that  this is an interesting  and 
important  question,  but  note  that  it was beyond  the  scope  of this study. 
C-12  APPENDIX  D 
NOTES 
1.  Actions  that  must  be reported  include:  adverse  decisions  on hospital  privileges 
including  voluntary  resignation;  actions  taken  by State  licensing  boards  on 
licenses  including  suspension,  denial,  restriction,  and  revocation;  and  losses of 
membership  in professional  societies. 
2.  As of March  30, 1992, only 40 of the  more  than  130 medical,  osteopathic, 
dental,  and  other  State  boards  had  submitted  queries. 
3.  As of March  19, 1992, there  were  69 matches.  According  to HRSA,  there  were 
9,813 queries  from  State  licensing  boards  as of March  30, 1992. 
4.  The  match  rate  is expected  to increase  over  time  as more  practitioners  are 
reported  to the  Data  Bank. 
5.  P.L.  99-660, Sec. 402. 
6.  M. Holoweiko,  The malpractice  data  bank  is turning  into  a Frankenstein, 
Medical  Economics,  May 6, 1991, pp.  120-133. 
7.  In the  other  two cases,  the  practitioners  themselves  provided  boards  with 
information  that  the  Data  Bank  did not  provide. 
8.  Response  time  is defined  as the  time  a board  had  to wait between  submitting  a 
query  to the  Data  Bank  and  receiving  a report. 
9.  For  a more  thorough  discussion  of the  Data  Banks  response  time,  see  the  OIG 
report,  Nahonal Practitioner Data Bank:  Usefulness and Impact  of Repotis  to 
Hospitalk  (OEI-01-90-00520),  forthcoming. 
10.  In  the  five  cases  where  respondents  had  received  two  reports  in  response  to 
their  queries,  the  pairs  of  reports  were  extremely  homogeneous.  ln  all  five 
cases,  both  reports  provided  information  from  sources  outside  the  State  in 
which  the  querier  was  located.  In three  cases,  both  reports  involved 
malpractice  payments;  in  the  other  two  cases,  both  reports  involved  adverse 
actions.  All  malpractice  payments  in these  responses  were  for  amounts  greater 
than  $50,000.  The  only  differences  between  paired  reports  relevant  to  this 
study  concerned  types  of  adverse  actions.  One  response  contained  a pair  of 
reports  submitted  by hospitals,  but  the  other  contained  one  report  submitted  by 
a hospital  and  one  report  submitted  by a licensing  board.  In  constructing 
table  1, we  included  this  split  pair  as  1 of the  13 responses  involving  board 
licensure  actions.  Had  we  included  the  pair  as  a response  involving  hospital 
D-1  privilege  actions,  the  proportions  of responses  considered  useful  for these  two 
types  of adverse  actions  would  have  been  even  more  similar. 
D-2