,, 
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I 
Department  of  Health and Human  Services 
OFFICE  OF 
INSPECTOR  GENEW 
 
NATIONAL  PRACTITIONER  DATA  BANK: 
PROFILE  OF  MATCHES  UPDATE 
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$  JUNE  GIBBS  BROWN

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AUGUST  1994 
OEI-01-94-00031 
-
--.  OFFICE  OF  INSPE(TOR  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 Services (HHS) 
programs as well as the health and welfare of beneficiaries served 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 Services, 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 Services (OAS) provides all auditing services for HHS, either by 
conducting audits with its own auditresources 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 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 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  in the Boston regionai 
office under the direction of Mark R. Yessian, Ph.D., Regional Inspector General, and Martha 
B. Kvaal, Deputy Regional Inspector GeneraL  Project statl 
BOSlON  HEADQUARTERS 
David Veroff, Project Leader  Alan Levine, Program  Specialist 
Foradditionalcopii.sof thisrepo~ pkase  contacttheBostonregionalo~e  bytelephoneat 
(617) 56S-1050,or by f=  at (617) 565-3751. 
.  -  .  __  Department  of  Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENER/uj 
NATIONAL  PRACTITIONER  DATA  BANK: 
PROFILE  OF  MATCHES  UPDATE 
*.v   
$ 
JUNE  GIBBS  BROWN 
5 
~ 
s Inspector  General 
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+
AUGUST  1994
OEI-01-94-00031 
 
  EXECUTIVE  SUMMARY

PURPOSE 
To update  a profile  of National  Practitioner  Data  Bank  matches--those  occasions  on 
which the  Data  Bank  has provided  reports  of malpractice  payments  or adverse  actions 
to requesting  entities. 
BACKGROUND 
The  National  Practitioner  Data  Bank  opened  on September  1, 1990.  It maintains 
records  of malpractice  payments  (both  judgments  and  settlements)  and  adverse  actions 
against  licensed  health  care  practitioners.  The  Data  Bank  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 
receives  reports  of adverse  actions  against  practitioners  from  State  licensing  boards, 
hospitals  and  other  health  care  entities,  and  professional  societies.  It receives  reports 
of malpractice  payments  from  malpractice  insurers. 
As of April  1994, the  Data  Bank  had  received  3,462,297  requests  for information  and 
82623  reports  of adverse  actions  or malpractice  payments.  When  a request  names  a 
practitioner  who has  been  reported  to the  Data  Bank,  the  request-report  pair  is 
referred  to as a match.  As a result  of the  queries  made  by April  1994, 152,941 
matches  had  occurred. 
In April  1992, we published  a report  profiling  all Data  Bank  matches  through 
March  19, 1992 as a byproduct  of a larger  study we conducted  on the  usefulness  and 
impact  of information  stored  in the  Data  Bank.  The  profile  report  provided 
information  about  the  Data  Banks  history  that  was not  available  elsewhere.  The 
Administrator  of the  Health  Resources  and  Services  Administration  recently  asked  for 
an updated  study  on the  usefulness  and  impact  of the  Data  Bank.  We  agreed  to do 
so.  We  produced  this update  of the  profile  report  as a first step  in the  broader  study, 
which is now underway. 
FINDINGS 
NUMBER  OF WITCHES:  By Februmy 1994, the ZotaInumber of matches  was abnost 
7 ti  huger than it was as of Mada  1992 
	 The  total  number  of matches  increased  from  20,954 as of March  1992 to 
144,649 as of February  1994. 
	 The  average  number  of matches  per  month  increased  from  1,126 in the  period 
prior  to March  20, 1992 to 5,022 in the  later  period. 
i  TYPES OF PM  CT17TONERS INKOLKED  IN M=4TCHES:  l%e majody  of 
pmctitioners  involved  k  matcha  continue to be physiiimu. 
  In each  period,  93 percent  of the  matches  involved  physicians. 
TYPES OF OVERIERS  RECEIVIIVG M4TCH  INFORMATION:  JWtik mmt  of the 
matches stiff rend  @m  quaies  by hospita~  a much higher proportion  of matches  now 
rauil  @m  queriin by health rnabztenance orgatitiom  and group practictx 
	 On  average,  queriers  receiving  any match  information  matched  on many  more 
practitioners  than  they had  in the  earlier  study  period. 
TYPE OF REPORTS  RESULTING  IN M4TCHES:  I&  reports involved  in matches  are 
still hugely ma@actke  payment  reprts. 
  The  size of the  malpractice  payments  involved  in matches  has grown  somewhat. 
	 Licensing  boards  and hospitals  each  still account  for  about  half of the  adverse 
action  reports  involved  in matches. 
lN?ERSTAT2Z MATCHES:  A greater pqxxtzhn  of matches suppij  information about 
pmctitiimm  who cnxed  state likes 
	 Interstate  matches  accounted  for 9.3 percent  of all matches  in the  earlier  study 
period;  in the  later  period,  they  accounted  for  15.3 percent. 
CONCLUSION 
In the  future,  regardless  of shifts in the  volume  of matches  and  types  of queriers 
involved  in matches,  we can expect  most  matches  to involve  reports  on physicians  with 
malpractice  payments. 
The  growth  in the  number  and  proportion  of matches  resulting  from  queries  from 
health  maintenance  organizations  and  group  practices  may  indicate  that  volunta~ 
queriers  are  more  aware  of the  Data  Bank  than  they  used  to be  and/or  that  they  sense 
it is valuable  to query  the  Data  Bank. 
APPENDICES 
In four  appendices,  we provide  details  on the  types  of practitioners.  queriers, 
malpractice  payments,  and  adverse  actions  involved  in matches. 
ii 
  TABLE  OF  CONTENTS

PAGE 
~~fMJMMARY....  . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..i

~OIXJCIION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I

_INGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3

Number  ofmatches  . . . . . . . . . . . . . . . . . .

. . . . . . ,,...O  . . . . . . . . . . . . . . .  3

Types  ofpractitioners  involvedh  matches  . . . . . . . . . . . . . . . . . . . . . .

. . . . . .  4

Types  ofqueriers  receitingmatch  information  . . . . . . . . . . . . . . . . . . . . . .  4

. . .

Type  ofreports  resulting  in matches  . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . .  5

Interstate  matches  . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . ..O  . . . . . . .  6

CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7

APPENDICES 
&  Practitioners  Involved  in Matches  . . . . . . . . . . . . . . . . . . . .

. . . . . . . . ..O.  . .  A-1

B: Queriers  Involved  in Matches.  . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .  B-1

CMaIpractice  Pa~ent  Repotis  Involved  in Matches  . . . . . . . . . . . . . . . . . . . . .  C-1

D: Adverse Action Reports  Involved in Matches  . . . . . . . . . . . . . . . . . . . . . . . . . D-1

ENotes  . . . . . . . . . . . . . ..OOO

. . . . . . . . . . . . . . . . . . . . . . ..O  . . . . . . . . . .  E-1
 INTRODUCTION

PURPOSE 
To update  a profile  of National  Practitioner  Data  Bank  matches--those  occasions  on 
which the  Data  Bank  has provided  reports  of malpractice  payments  or adverse  actions 
to requesting  entities. 
BACKGROUND 
The  National  Practitioner  Data  Bank  maintains  records  of malpractice  judgments  and 
adverse  actions  against  licensed  health  care  practitioners.  It was established  by 
Title  IV of the  Health  Care  Quality  Improvement  Act  of 1986 (P.L.  99-660)  and  has 
been  in operation  since  September  1, 1990.  The  Data  Bank  is fimded  by user  fees 
and  is administered  by Unisys Corporation  under  contract  to the  Health  Resources 
and  Semites  Administration  (HRSA)  of the  Public  Health  Service  (PHS). 
The  Data  Bank  provides  hospitals  and  other  health  care  entities  with  information 
relating  to the  professional  competence  and  conduct  of physicians,  dentists,  and  other 
health  care  practitioners.  Congress  believed  the  Data  Bank  could,  among  other  things, 
help  restrict  the  ability  of incompetent  physicians  to move  from  State  to State  without 
disclosure  or discovexy of the  physicians  previous  damaging  or incompetent 
performance.1 
II 
DEFINITION  OF  TERMS  USED  IN THIS  REPORT 
REPORT  Information  sent  to the  Data  Bank  about  a 
* 
practitioner  by a malpractice  insurer,  hospital, 
n  licensing  board,  or professional  society. 
RECORD  A report  that  has been  received  and  is 
permanently  stored  by the  Data  Bank. 
H 
 
QUERY  A request  for information  about  a practitioner 
m submitted  to the  Data  Bank  by a hospital, 
licensing  board,  or other  health  care  entity. 
MATCH  A pairing  of a record  and  quexy that  identifies 
z 
the  same  practitioner. 
m 
H
1
 State  licensing  boards,  hospitals  and  other  health  care  entities,  and  professional

societies  submit  reports  of adverse  actions  against  practitioners  to  the  Data  Bank.2

These  groups  must  report  certain  actions  against  physicians  and  dentists,  and  health

care  entities  and  professional  societies  may report  certain  actions  against  other

licensed  practitioners:  Reports  of malpractice  payments  are  submitted  by insurers,

who must  report  all judgments  and  settlements  made  on behalf  of all licensed

practitioners.4

Data  Bank  records  may be released  only to authorized  entities  (referred  to  in this

report  as queriers).  Authorized  queriers  include  hospitals  and  other  health  care

entities,5  State  licensing  boards,  professional  societies,  and,  under  specified  conditions,

plaintifk  attorneys  in malpractice  suits.  Also, practitioners  may request  their  own

records.  Only hospitals  are  required  by law to query  the  Data  Bank.  They  must

request  records  for practitioners  wishing to obtain  clinical  privileges  and,  every  2 years,

for all practitioners  with privileges.b

When  a hospital,  licensing  board,  or other  health  care  entity  requests  information  on a

certain  practitioner  from  the  Data  Bank,  and  that  practitioner  has  been  reported  to

the  Data  Bank  the  request-report  pair  is referred  to as a match.  Through

April  30, 1994 (the  most  recent  date  for which complete  statistics  are  available),  the

Data  Bank  had  received  3,462,297 requests  for information  and  82623  adverse  action

or malpractice  payment  reports.  These  requests  and  reports  had  resulted  in  152,941

matches.

In April  1992, we published  a report  profiling  all Data  Bank  matches  through

March  19, 1992 as a byproduct  of a larger  study we conducted  on  the  usefulness  and

impact  of information  stored  in the  Data  Bank.8  The  profile  report  provided

information  about  the  Data  Banks  history  that  was not  available  elsewhere.  The

Administrator  of the  Health  Resources  and  Services  Administration  recently  asked  for

an updated  study  on usefulness  and  impact  of the  Data  Bank.  We  agreed  to do so.

We produced  this update  of the  profile  report  as a first step  in the  broader  study,

which  is now undenvay.

METHODOIQGY

The  Office  of Inspector  General  (OIG)  requested  and  received  from  Unisys

Corporation  a computer  file containing  records  logged  between  March  20, 1992 and

February  25, 19949 of all queries  and  reports  received  by the  Data  Bank  that

identified  the  same  practitioner.  10 We  restructured  and  analyzed  the  data  using SAS

Release  6.08 on a mainframe  computer.  We also  obtained  statistics  pertaining  to all

reports  and  queries  received  by the  Data  Bank  as of April  30, 1994. whether  or not

they were  involved  in matches.  Our  review was conducted  in accordance  with  the

Quality Standards for Inspections issued  by the  Presidents  Council  on Integrity  and

Efficiency.

2
 FINDINGS

NUMBER  OF WITCHES:  By February 1994, the total number  of matches  was aikumt 
7ti  LIIgerthan it was as of Mad  1992 
Between  September  1, 1990, and  March  19, 1992 (Period  A),  a total  of 20,954 matches 
occurred.  Between  March  20, 1992 and  February  25, 1994 (Period  B),  123,695 
matches  occurred.  The  total  number  of matches  horn  September  1, 1990 to February 
25, 1994 was therefore  144,649 or 6.9 times  larger  than  the  20,954 matches  as of 
March  19, 1992.11 Figure  1 below  describes  the  increase  in the  average  number  of 
matches  per  month  between  the  two periods.  The  increase  in matches  is driven  by 
two forces:  a rise in the  number  of queries  and  a larger  volume  of records  in the 
Data  Bank  available  to be matched  against.  The  total  number  of queries  grew from 
about  1 million  after  the  end  of Period  A to over  3 million  after  the  end  of Period 
B.12 The  total  number  of records  available  to match  against  grew from  about  25,000 
at the  end  of Period  A to over  75,000 at the  end  of Period  B.13 The  approximate 
odds  of a query  resulting  in a match  jumped  from  1 in 50 over  Period  A to  1 in  17 
over  Period  B.14 With  this increase  in the  match  rate  and  the  increase  in queries, 
the  large  increase  in matches  is not  surprising. 
Figure 1 
THE AVERAGE NUMBER OF MATCHES PER MONTH HAS GROWN  DRAMATICALLY 
FROM PERIOD A (9/90 -3/92) TO PERIOD B (3/92 -2/94) 
Matches/Month 
6000, 
5500 J 
I 
I 
4500-
4000-
3500-
3000-
2500-
2000-
I 
I 
1000 
500 L 
Period A  Period B 
MTA  SOU17ClS N@md  Fnd9mur  WmANALW!SH  US06hd~Qunrd 
3

__  ~eamount  ofifiomation  from  each  matching  que~has  increased  slightly.  In 
Period  B, 102,120 queries  matched  123,695 records.  This means  that  each  query 
involved  in a match  provided  the  querier  with an average  of  1.21 (123,695  +  102,120) 
records  per  query  in Period  B.  This  is 10.0 percent  more  information  than  the  1.1 
records  per  query  in Period  A (19,034  queries  matched  20,954 records). 
TYPES OF PM  C777YONERS INVOLVED  IN MA TCHE$:  2%?mujority of practitioner 
involved in matches  contihue to be physicims 
There  were  32,605 different  practitioners  represented  in matches  that  occurred  in 
Period  B; this compares  with the  10,185 represented  in matches  in the  earlier 
period. 15 In both  periods,  93 percent  of the  matches  involved  physicians.  In Period 
~  4 percent  involved  dentists;  3 percent  involved  dentists  in Period  B.  Appendix  A 
displays  the  types  of practitioners  involved  in matches. 
Seventy-six  percent  of all reports to  the  Data  Bank  as of April  30, 1994 involved 
physicians,lb whereas  93 percent  of the  matches  from  March  20, 1992 through 
February  25, 1994 involved  physicians.  This  disparity  is not  surprising  because 
hospitals  are  the  only mandated  queriers  of the  Data  Bank  and  are  most  likely to 
query  about  physicians. 
TXPES OF (9UERIERS RECEIJ?ZNGikMTCH INFOIWIX770N:  While most  of the 
matches still rtxiultjhm  queries by Jz.apiM& a much higher proportion  of mutches now 
result fmm  qutvies by health nuuktenunce oqanizaticms  and group pmcnceis 
The  number  of queriers  who submitted  requests  that  led to matches  increased  from 
4,357 in Period  A to 6,954 since  then.1  Of these  matching  queriers,  a much  smaller 
proportion  were  hospitals  in the  more  recent  period  (72.3 percent  compared  to 
91.3 percent).  A much  greater  proportion  were  health  maintenance  organizations 
(HMOS)  and  group  practices  (24.2 percent  compared  to 6.5 percent).  Figure  2 
displays these  figures  graphically  appendix  B provides  details. 
While  hospitals  are  the  only organizations  required  by law to  query  the  Data  Bank, 
standards  put  in place  in  1993 require  HMOS interested  in receiving  National 
Committee  for Quality  Assurance  accreditation  to query  the  Data  Bank  for each 
practitioner  seeking  credentials  or renewing  credentials.ls  This  may explain  part  of 
the  large  increase. 
Most  of the  89,430 hospital  matches  in Period  B resulted  from  mandato~  two-year 
queries  (66.1 percent).  Initial  privileging  and  employment  queries  accounted  for 
32.0 percent  and  professional  retiew  activity accounted  for  1.4 percent.19  These 
proportions  are  very similar  to those  in the  earlier  period. 
4
 Figure 2 
A MUCH HIGHER PROPORTION  OF MATCHES NOW RESULT FROM QUERIES 
BY HMOS AND GROUP PRACTICES  I 
MatchesbyTypeofQuerfer  MatchesByTypeofQuener 
PeriodA (9/90 +/92)  PerfodB (3/92 -2/94) 
N-20,954  N=123,695 
- (7294) 
) 
Other(4%) 
(7%) 
HMO/GP(24%) 
IMTASOURCi2NMknd  Rmdlanr  OdskA  NIAAYSSHHSOMmdh@omr  Qana@ 
	 On average,  queriers  receiving  any match  information  matched  on many  more 
practitioners  than  they had  in the  earlier  study period. 
Querierswho match  are  submitting  queries  and  matching  on more  than  one 
practitioner.  Up  until  March  1992, the  mean  was 4.4 practitioners  matched  per 
querier;  since  March  1992. that  figure  has grown  to  14.7 practitioners  matched  per 
querier.  While  this is clearly a function  of more  information  being  available  in the 
Data  Bank,  it is a remarkable  growth  nonetheless  and  may  give matching  queriers  a 
better  understanding  of the full range  of information  available  in the  Data  Bank. 
Fourteen  percent  of queriers  in the  second  study period  matched  on exactly  1 
practitioner,  and  46 percent  matched  on 5 or fewer.  A few queriers  matched  on many 
more  practitioners;  1 national  health  maintenance  organization  matched  on 3,390 
different  practitioners  in Period  B. 
TYPE OF REPOR7S  RESUL77NG  IN MTCHES:  %  reports involved in matcti  are 
still Iatgely malpractice payment  reprts 
Since March  1992, a total  of 1,971 reporters  have  submitted  40,355 adverse  action  or 
malpractice  reports  that  have been  matched.20  While  these  numbers  have  increased 
significantly  since  our  first study period,  the  proportions  of the  total  involving 
malpractice  payment  reports  versus  adverse  action  reports  has not  shifted  much.  In 
Period  ~  malpractice  payment  reports  made  up 88 percent  of all the  matches; 
5
 adverse  actions  made  up  12 percent;  in Period  B, those  figures  were  89 percent  and 
11 percent  respectively. 
  The  size of the  malpractice  payments  involved  in matches  has grown  somewhat. 
From  September  1, 1990 to March  19, 1994  the  malpractice  payment  amounts 
involved  in matches  ranged  from  $1 to $4,675,000, with  a mean  of $132,358.21  Both 
the  range  and  the  mean  have  grown  since then.  The  range  in the  period  since  March 
1992 now extends  to $9,000,000 and  the  mean  is $199,114.  The  median  has also 
grown,from $50,000 to  $60,000.Z  Appendix  C displays  these  figures  in tabular  form. 
The  distribution  of matches  into  categories  of acts  or omissions  has remained 
essentially  the  same.  In both  periods,  a majority  of the  malpractice  reports  that 
appeared  in matches  fell into  three  major  types  of acts  or omissions:  32 percent  were 
surge~-related,  28 percent  diagnosis-related,  and  19 percent  treatment-related. 
Appendix  C summarizes  the  types  of acts or omissions. 
	 Licensing  boards  and  hospitals  each  still account  for  about  half  of the  adverse 
action  reports  involved  in matches. 
Adverse  action  reports  appearing  in matches  came  from  two major  sources.  In the

Period  ~  52 percent  came  from  Iicensure  actions  submitted  by State  boards  and

47 percent  from  hospital  clinical  privileges  actions.  These  figures  changed  to 56

percent  and  43 percent  respectively  since March  1992.  The  remaining  1 percent  in

each  period  came  from  professional  societies  reporting  about  membership  actions.

The  patterns  of specific  actions  and  reasons  for  actions  taken  against  practitioners  that

show up in adverse  action  matches  were  very similar  in both  periods.  Major

categories  of actions  include  probation  of license  (23 percent  of adverse  action

matches  in Petiod  A and  22 percent  in Period  B) and  denial  of clinical  privileges

(12 percent  in Period  A and  9 percent  in Period  B).  The  reasons  for action  include

incompetence,  malpractice,  and  negligence  (16 percent  in Period  A and  15 percent  in

Period  B), unprofessional  conduct  (11 percent  in Period  A and  10 percent  in Period

B), and  alcohol  and  other  substance  abuse  (10 percent  in each  period).m

Appendix  D summarizes  the  types  of actions  and  reasons  for  actions.

INTERSTATE  M4TCHES:  A greater proportion  of matcher  supply information aboti 
praditionm  who crossed state lhws. 
One  of Congresss  priorities  in establishing  the  Data  Bank  was to prevent  incompetent

and  unprofessional  practitioners  from  evading  detection  by simply crossing  State  lines

to practice.  In the  Period  ~  interstate  matches  occurred  1,956 times  (or  9.3 percent

of all matches);  in Period  B, interstate  matches  occurred  18,975 times  (or  15.3 percent

of all matches). X  Being  reported  to the  Data  Bank,  however,  is not  in itself

evidence  of incompetence  or unprofessionalism.  We  cannot  determine  whether  these

matches  have  actually  protected  the  public  from  potential  harm.

6  CONCLUSION

Thenumber  ofmatches  hasgreatly  increased  since  March  1992 anda  much  larger 
proportion  ofmatches  nowresultfiom  queries  from  heakh  maintenance  organizations 
and group  practices.  Despite  these  shifts, the  vast  majority  of matches  continue  to 
involve physicians  andtoconcem  malpractice  payments.  This  indicates  that  in the 
future,  regardless  of shifts in the  volume  of matches  and  types  of queriers  involved  in 
matches,  we can  expect  most  matches  to involve reports  on physicians  with 
malpractice  payments. 
The  growth  in the  number  and  proportion  of matches  resulting  from  queries  from 
health  maintenance  organizations  (HMOS)  and group  practices  may indicate  that 
voluntary  queriers  are  more  aware  of the  Data  Bank  than  they  used  to be and/or  that 
they sense  it is valuable  to query  the  Data  Bank.  We will examine  questions  of 
usefulness  and  impact  of Data  Bank  information,  including  to HMOS  and  group 
practices,  in upcoming  reports. 
7
 APPENDIX  A

NATIONAL  PRACHTIONER  DATA  BANK  PROFILE  OF  MATCHES 
PRACHTIONERS  INVOLVED  IN MATCHES 
TYPE  OF PRACITfIO~ER  NUMBER  OF  NUMBER  OF 
MATCHES  MATCHES 
Period  k  9/lPO  - 3J19J92  Pericd  B: 3120f92- 2/25J94 
TOTAL  20,954  123,695 
Physicians and Dentists  20,165 (%.2%)  119,501 (%.6%) 
Allopathic Physicians  18,038  ~  10~198 
Allopothic Physician Residents  219  1,298 
Osteopathic Physicti  1,135  6978 
Osteopathic Physieion interns and Residents  26  ~  132 
1 
Dentists
 735  3,856 
Dento/ Residents
 12 ~  39 
Podiatrists  486  (2.3%)  I  2,582  (21%) 
Psychologists  51  (0.2%)  ~  248  (0.2%) 
Other Health  Care  Disciplines/Personnel  36  (0.2%)  I  188  (0.2%) 
chiropractors  x  82 
Dentwirts  01  2 
MentolHeolth Coumelors  o  2 
Opticions  o  10 
Optomoi.m  20	 .x 
Pharlnacirk3  0;  2 
Physicbt  Assistants  51  32 
Physician Assistontr, Osteopath  0  I 
Podiotric Assistants  2,  0 
professional  Counselors  16  30 
Professwnal  Counselom  FmtylMmiage  2  4 
Nurses and Related  30  (0.1%)I  192  (0.2%) 
Registered (Professwnai)  Nurses
 4  15 
Nurse Anesthetists
 24  139 
Nurse Mkiwives
 1  29 
Nurse Practitioners
 0:  2 
Psychiatric Technicians
 I,  7 
(0.0%), 
Emergency Care Personnel  2  18  (0.0%) 
kxial  Workers  o  (0.0%)  ~  4  (0.0%) 
rehabilitation/Restorative  Services Personnel  4  (0.0%)  f  20  (0.0%) 
technicians  and Technologists  2  (0.0%)  ;  18  (0.0%) 
fot  Properly  Coded  178  (0.8%)  I  924  (0.7%) 
DATA  SOURCE:  National  Practitioner  Data  Bank.  ANALYSIS:  HHS  Office of Inspector  General 
A-1

  .  APPENDIX  B

NATIONAL  PRACTITIONER  DATA  BANK  PROFILE  OF  MATCHES 
QUERIERS  INVOLVED  IN MATCHES 
TYPE OF QUERfER  I  NUMBER OF MATCHES  NUMBER OF WTCHES 
I  Period k  9ni90  -3f19B2  1  Period B: 31ZO19-2225194  1 
TOTAL  20,954  123,695 
Non-Federai Hoapitai  18,788(89.7%)  87,434(70.7%) 
1.  pvikgingkrnpioyrnuu  6278  2~523 
Mandatay  rwo-year review  12J64  54274 
Rof~  review ocnvily  301  1,257 
Oltw  42  2s1 
Siatc Ucaauhg  Boar~_  3  129 
HMCmPo  I  1319  (6.3%)  25,046 (20.2%) 
Inidol priV&?g@ltmp@wu?u
 776  15,234 
Mandamy  IW-ycor  review
 158  4736 
Bofmionol reviewOctiviiy
 350  4548 
Otk
 35  42s 
Statetiming  Boord~
 o	 83 
!  I  I 
I 
Other Non-Fedemi Health Care Entity  382 (1.8%)  %711 (22%) 
Irri&d fWiVik@l@.??lf)@ftlUU  257  1,693 
Mn&lOty lrvo-ycorreview  111  845 
Rof~  reviewOctiviy 12  130 
other  1 
43 
State Lictnsing  Boord~  1 0 
1 
Federal Hospital  3M  (1.6%)  1,9%  (1.6%) 
Inidd privilegingkrrlpbyrnent  1  202  1,144 
Man4UOIY  IWO-yaw revkw  127  8.28 
Profarional review octivy  5  23 
other  o 1 
State LicensingBoard  69 (0.3%)  800  (0.6%) 
i 
State liceming  boord  65  766 
Mondumy  two-year mv&/  3  15 
hidOlpnvile@glmplo&_  I  17 
Profmionol review  o  2 
Group Practice  42 (0.2%)  4,970 (4.0%) 
, 
II ProfesaionaiSociety  15 (0.1%)  I  478 (0.4%) // 
1 (  I 
Other Federal Health Care Entity  5  (0.0%)  258 (0.2%) 
!~
Not Properly Coded  o  (0.0%)  2  (0.0%) 
DATA SOURCE  National Practitioner Data Bank. AIIALYSIS: HHS Office of Inspector General 
Denotes  inconsistency  between  querying entny  type and query type; could result  from improper  form completion 
or incorrect  assignment  of entity type code. 
B-1  APPENDIX  C

NATIONAL  PRACTITIONER  DATA  BANK  PROFILE  OF  MATCHES 
MALPRACTICE  PAYMENT  REPORTS  INVOLVED  IN MATCHES 
TYPE OF  NUMBER  OF  NUMBEROF 
ACT/OMISSIONz  MALPRACTICE MATCHES  MALPRACTICE MATCHES 
Period k  9/MJO- 3/19/92  Period B: 3120P2-2f25P4 
Total  Matches  =  20,954  Total  Afatches=123,695 
TOTAL  18$21  110,058 
MALPRMXICE 
PAYMENT 
MATCHES 
Surge~-Related  5,871 (31.7%)  34,949 (31.8%) 
Diagnosis-Related  5,125 (27.7%)  30,723 (27.9%) 
Treatment-Related  3,440 (18.6%)  21,055 (19.1%) 
I

Medieation-Related  1s35  (7.2%)  7,024  (6.4%) 
Obstetrics-Related  l@5  (6.9%)  8,871  (8.1%) 
Anesthesia-Related  583  (3.1%)  3,067  (2.8%) 
Monitoring-Related  235  (1.3%)  1377  (1.3%) 
Intravenous and Blood  220  (1.2%)  796  (0.7%) 
Products-Related 
Miscellaneous  206  (1.1%)  1,271 (1.2%) 
BiomedicalEquipment/  121 (0.7%)  533  (0.5%) 
Product-Related 
Not Properly Coded  99  (0.5%)  392  (0.4%) 
DATA SOURCE: National Practitioner Data Bank.  ANALYSIS: HHS Office of Inspector  General 
lMalpractice  payment  reports  can be given one or two codes indicating type of act or omission.  Of the  18,521 
maipractim  payment  matches  in the first period,  only 4,088 were assigned two codq  in the second  period,  only 
21,286 had two codes.  For clarity, these secondary  codes have been disregarded  in this table. 
c-1 
.  NATIONALPRACIT170NERDATA  BANK  PROFILE  OF  MATCHES 
MALPRAClTCE  PAYMENT  REPORTS  INVOLVED  IN  MATCHES 
(continued) 
WRACTICE  PAYMENT  NUMBER OF MATCHES  NUMBER OF MATCHES 
AMOUNT (SINGLE  Period k  9/1/90-3/19/92  Period B: 3f20P2 -2/2SP4 
PAYMENTS ONLY) 
TOTAL WRACTICE  16,962  101,492 
PAYMENT MATCHES 
$1- $29,!399  6,434 (37.9%)  36,268 (35.7%) 
$30,000-$49,999  1#36  (8.9%)  8,739  (8.6%) 
$50,000-$99,999  2870 (16.9%)  16S50 (16.3%) 
$100,000-$499,999  5,129 (30.2%)  32,560 (32.1%) 
$500,000 and above  1,023  (6.0%)  7375  (7.3%) 
II
Mean  $132,358  $149,114 
Median  $50,000  $60,000 
Mode  $1OO,OOO  $200,000 
NOTE: An additional 1S59 matches in Period A and 8,566 in Period B involved malpractice 
payments that belonged to a series of payments of unknown total value. 
DATA SOURCE: National Practitioner Data Bank.  ANALYSIS: HHS Offiw of Inspector General 
c-2 
.  APPENDIX  D

NATIONAL  PRACTITIONER  DATA  BANK  PROFILE  OF  MATCHES 
ADVERSE  ACIION  REPORTS  INVOLVED  IN MATCHES 
TYPE OF ADVERSE  NUMBER  OF ADVERSE  NUMBER OF ADVERSE 
ACTION  ACTION MATCHES  AC1IONMATCHES 
Period k  9/1/90 -3119P2  Period B: 3/20/92 - 2/25/94 
Total Matches  = 20,954  Total Matches= 123,695 
TOTAL ADVERSE  &433  13,637 
ACTION MATCHES 
Lieensure  I  1*6  (51.6%)  7,567 (55.5%) 
Revocation  52  288 
Probation  560  3,020 
Suspension  129  912 
Miscellaneous  515  3,347 
Clinical Privileges  1,144 (47.0%)  5,905 (43.3%) 
Revocation  144  809 
Suspension  164  1,124 
Voluntcuy Surrender  222  1,067 
Reduced Privileges  122  621 
Other Restriction  113  617 
Denial  292  1,206 
Revision to Action  ,  87  461 
Professional Society  33  (1.4%)  165  (1.2%) 
Membership 
Revocation
 7  67 
Suspension
 8  17 
Denial
 17  52 
Other Restriction
 o  11 
Not proper~  Coded
 1  18 
D-1 
--..  _  ADVERSE ACTION REPORTS INVOLVED IN MATCHES

(continued) 
REASON FOR  NUMBER OF ADVERSE  NUMBER OF ADVERSE 
ACTION  AC170N MATCHES  ACTIONMATCHES 
Period A: 9/1190- 3119L32  Period B: 3t20i92 - 2J2W4 
TotaI Matches  = 20,954  Total Matches =123,695 
TOTAL ADVERSE  2,433  13,637 
ACTION MATCHES 
Alcohol and Other  238 (9.8%)  1300 (9.5%) 
Substance Abuse 
Ineompetenee/MaI 380 (15.6%)  1,988 (14.6%) 
practice/Negligence 
Narcotiea Violations  93 (3.8%)  470 (3.4%) 
Felony  28 (1.2%)  149 (1.1%) 
Fraud  27 (1.1%)  161 (1.2%) 
Unprofessional Clmduct  263 (10.8%)  1,295 (9.5%) 
Mental Disorder  14 (0.6%)  97 (0.7%) 
Allowing Unlicensed  21 (0.9%)  95 (0.7%) 
Person to Practice 
DisciplinaryAction  127(5.2%)  700 (5.1%) 
Iaken in Another State 
PhysicalImpairment  11 (0.5%)  51 (0.4%) 
Other Reason--Not  594 (24.4%)  3,320 (24.3%) 
21assifled1 
Uiseellanems Actions2  603 (24.8%)  3,826 (28.1%) 
Yot Properly Coded,  34 (1.4%)  185 (1.4%) 
3eneral Code Used 
DATA SOURCE: National Practitioner Data Bank.  ANALYSIS: HHS Office of Inspector General 
lReporters  use this code when none of the above categories  appty. 
2Misce11aneous Iicensure actions are not assigned clasifieation  codes to parallel other  types of actions.  The 
breakdown  of miscellaneous  licensure action matchea is as follows (Period  A followed by Pe~iod B): License Restored 
or Reinstated,  (Period  A) 82 and (Pericd  B) 604; Reinstatement  Denied,  5 and 41; Reprimand,  176 and 9W, Other 
(Including  Censure  and Surrender),  249 and  1,734  License Denied  (Renewal  Only),  1 and  10, and Not Properly 
Coded, 2 and  12  In addition,  there were 87 matches  in Period A and 461 in Period  B related  to revisions to actions 
on hospital  clinical privileges and  1 in the Period  A and  18 in Period  B related  to a revision to action on professional 
society membership. 
D-2  APPENDIX  E

NOTES 
1.  Health  Care  Quality  Improvement  Act  of 1986 (P.L.  99-660),  Section  402. 
2.  Adverse  actions  include  licensure  revocation,  suspension,  and  probation;  clinical

privilege  revocation,  suspension,  reduction,  restriction,  and  voluntary  surrende~

and  professional  society membership  revocation,  suspension,  and  denial;  as well

as other  categories.  Some  of these  other  categories  include  actions  favorable  to

practitioners,  such  as license  reinstatement.

Under  current  law, State  licensing  boards  must  report  actions  only against

physicians  and  dentists,  whereas  other  entities  must  report  actions  against

physicians  and  dentists  and  may  report  actions  against  other  licensed  health

care  practitioners.

3.  Only the  following  adverse  actions  must  be  reported:  1) All licensure

disciplinary  actions  on physicians  and  dentists  based  on reasons  related  to

professional  competence  or conduct  must  be reported.  2)  All hospital  and

other  health  care  entity  professional  review  actions  based  on reasons  related  to

professional  competence  or conduct  adversely  affecting  clinical  privileges  for a

period  longer  than  30 days; or voluntary  surrender  or restriction  of clinical

privileges  while  under  or to avoid  investigation.  3)  All professional  society

professional  review  actions  based  on reasons  related  to professional

competence  or conduct  adversely  affecting  membership.

4.  Malpractice  insurers  do not  submit  reports  of payments  on behalf  of facilities

or corporations.

5.  Health  care  entities  must  provide  health  care  services  and  engage  in

professional  review  activity through  a formal  peer  review  process.

6.  There  are  no Federal  penalties  assessed  against  hospitals  for not  querying  the

Data  Bank;  however,  their  failure  to query  could  be  used  against  them  in legal

proceedings.

7.  Department  of Health  and  Human  Services,  Public  Health  Semite,  Health

Resources  and  Semites  Administration,  Bureau  of Health  Professions,  Division

of Quality  Assurance,  National  Practitioner Data  Bank Statiwical Summa~  As  of

Month Ending April 30, 1994, Internal  Document.  Our  counting  of matches

(presented  in our  findings)  is somewhat  different  than  HRSAS; in particular,

we excluded  all self-queries,  matches  later  voided,  instances  when  a querier

matched  on information  it sent  in, duplicate  reports,  and  duplicate  queries.

.  . . 
E-1
 8.	 The  initial  profile  report  was  entitled  National  Practitioner Data  Bank  Profile of 
Mulches (Department  of Health  and Human  Services,  Office  of Inspector 
General,  National  Practitioner Data Bank  Profile of Matches,  OEI-01-90-(X)522, 
April  1992).  The  broad  study  of usefulness  and  impact  produced  two reports: 
Department  of Health  and  Human  Services,  Office  of Inspector  General, 
National  Practitioner Data Bank  Usefi[ness and Impact  of Repotis  to Hospitah, 
0EI-01-90-O0520,  February  1993 and Department  of Health  and  Human 
Services,  Office  of Inspector  General,  National  Practitioner Data  Bank 
Use&lness and Impact  of Repons  to State Licensing Boariir, OEI-01-90-00523, 
March  1993. 
9.	 Because  of the  time  our  analysis  and  reporting  of the  data  we requested  for our 
study of the  usefulness  and  impact  of matches  took,  we were  able  to get 
cumulative  statistics  on Data  Bank  activity that  was more  recent  than  February 
1994.  At  several  points  in this  report,  we reference  data  on the  universe  of all 
reports  and  queries  as of April  30, 1994.  While  we cannot  make  date-speciilc 
comparisons  between  the  universe  of matches  and  the  universe  of all reports 
and  queries,  it is highly unlikely  that  even  if we had  information  for exactly  the 
same  dates  our  comparisons  would  be  markedly  different  given historical  trends 
for this information,. 
10.	 Some  types  of matches  were  excluded  from  the  computer  file.  These  were  self-
queries,  in which  practitioners  requested  their  own Data  Bank  records,  and 
matches  on reports  that  were  later  voided  (i.e., removed  from  the  Data  Bank 
because  of errors). 
The  file we received  from  Unisys contained  individual  records  for queries  and 
reports.  Included  in each  record  was a field for Practitioner  Identification 
Number  (PIN).  To  construct  our file of matches,  we created  a new data  set 
containing  a single record  for  each  request-report  pair  that  named  the  same 
PIN. 
We made  two assumptions  regarding  the  file received  from  Unisys.  The  first 
was that  the  PIN  in each  record  was correct,  meaning  that  only queries  and 
reports  referring  to the  same  individual  were  paired.  The  second  is that,  with 
the  exceptions  noted  above,  the  file did in fact  contain  the  entire  set  of 
practitioners  for whom  both  a report  and  a query  had  been  received. 
11.	 In addition,  there  were  a number  of echoes (in which  a querier  receives 
information  it had  previously  submitted),  duplicate  reports,  and  duplicate 
queries.  None  of these  (28,650  matches  in the  more  recent  period)  constituted 
a real  transfer  of information,  and thus  they are  not  included  in any of our 
other  summary  statistics.  Unisys also excluded  reports  sent  to practitioners 
querying  about  themselves  from  the  data  base  we received,  but  we do not  know 
how many  times  this occurred. 
E-2
 12.  Numbers  are  approximate  since  the  information  we have  on queries  is from 
slightly different  time  periods  than  our study  periods. 
13.  Numbers  of reports  are  approximations  because  the  information  we have 
available  is from  somewhat  different  time  periods  than  the  study  periods. 
14.  The  odds  of matching  continue  to grow.  Queries  received  in the  month  of 
February  1994 had  a better  than  1 in 14 chance  of matching,  according  to 
HRSA  communication. 
15.  The  number  of matches  is greater  than  the  number  of practitioners  because 
practitioners  could  have  been  mentioned  in more  than  one  report  or could  have 
been  queried  about  more  than  once. 
The  total  number  of practitioners  involved  in matches  is probably  smaller  than 
the  number  in the  first period  added  to the  number  in the  second  period 
because  practitioners  matched  on in the  first period  could  well have  been 
matched  on in the  second  period  as well.  According  to Data  Bank  records,  as 
of ApriJ 30, 1994, 37,554 practitioners  had  been  matched  on;  this is smaller 
than  the  sum  of 32,605 and  10,185 even  though  it is for a longer  time  period 
and  includes  practitioners  matched  on by self-queries. 
16.  Department  of Health  and  Human  Services,  Public  Health  Sexvice, Health 
Resources  and  Services  Administration,  Bureau  of Health  Professions,  Division 
of Quality  Assurance,  National  Practitioner Data Bank Statistical  Summa~  As  of 
Month Ending April 30, 1994, Internal  Document. 
17.  This does  not  mean  that  the  total  number  (from  September  1, 1990 to 
February  1994) of queriers  who submitted  requests  resulting  in matches  was 
over  11,000.  Many who matched  in the  first  period  probably  matched  in the 
second  period. 
18.  National  Committee  for Quality  Assurance,  Accreditation  Standards, 
Credentialing  Standards  7.1 and  11.1 (1993)  2S, 30. 
19.  The  remaining  0.5 percent  of hospital  matches  in  the  later  period  were  from 
queries  marked  as State  licensing  board  (129 matches),  or  other  (251 matches). 
This indicates  that  some  hospitals  may not  be sure  which  of the  query type 
boxes on the  query  form  they  should  check,  or that  some  non-hospitals  were 
inappropriately  assigned  identification  numbers  in the  hospital  category. 
20.  The  number  of matches  is greater  than  the  number  of reports  because  multiple 
queriers  can match  on the  same  report. 
21.  These  calculations  are  based  only on the  16,962 matches  involving  one-time 
uavments.  Excluded  are  1.559 matches  invokhw  uavments  that  were  Dart of a 
E-3
 series  of installments,  and  for which  the  total  payment  amount  was not 
available. 
22.	 These  calculations  are  based  only on the  16,962 matches  in Period  A and 
101,492 matches  in Period  B involving  one-time  payments.  Excluded  are  1,559 
matches  in Period  A and  8,566 in Period  B involving  payments  that  were  part 
of a series  of installments,  and  for which  the  total  payment  amount  was not 
available. 
23.	 The  coding  system  for classes  of and  reasons  for  adverse  actions  was taken 
from  the  National  Practitioner  Data  Bank  reporting  instructions. 
24.	 A match  was considered  to be  an interstate  match  if the  queriers  State  was 
different  ffom  either  the  practitioners  work  State  or, for  adverse  actions,  the 
reporters  State.  We did not  use  the  reporters  State  for  malpractice  payment 
matches  because  many physicians  are  insured  by out-of-State  companies. 
E-4