Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

NATIONAL PRACTITIONER DATA BANK


REPORTS TO HOSPITALS:


THEIR USEFULNESS AND IMPACT


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OEI-01-94-OO030 
OFFICE OF INSPECTOR GENERAL 

The mission of the Office of Inspector General (OIG), as mandatedby Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services’ (HHS) 

programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwidenetwork 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 managementproblems and recommends coursesto correct them. 

OFFICE OF AUDIT SERVICES 

The OIG’SOffice of Audit Services(OAS)provides all auditing servicesfor 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 responsibilitiesand are intendedto provide independentassessmentsof HHS 

programs and operations in order to reduce waste, abuse, and mismanagementand to promote 

economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIG’SOffice 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 investigativeefforts of 01 lead to criminal convictions, administrative 

sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud control units which 

investigate and prosecute fraud and patient abuse in the Medicaid program. 

OFFICE OF EVALUATION AND INSPECTIONS 

The OIG’SOffice of Evaluation and Inspections(OEI) conductsshort-term management and 

program evaluations (called inspections)that focus on issues of concern to the Department, the 

Congress, and the public. The findings and recommendationscontained in these inspection reports 

generate rapid, accurate, and up-todate information on the efficiency, vulnerability, and 

effectivenessof departmental programs. 

Thk report was prepared in the Boston Region Office under the direction of Mark R. Yessian, 

Ph.D., Regional Inspector General and Martha B. Kvaal, Deputy Regional Inspector General. 

Project staff included: 

BOSTON REGION HEADQUARTERS 

David Veroff, Project Leader Alan Levine, Program Specialist


Joyce Greenleaf, Program Analyst


Barry McCoy, Program Analyst


Michael Sullivan, Summer Intern


For additional copies of this report, please contact the Boston regional oflice by telephone at 

(617) 565-1050, or by fa at (617) 565-3751. 
EXECUTIVE SUMMARY 

PURPOSE 

To update an assessment of the usefi-dness and impact of information in the National 

Practitioner Data Bank to hospitals. 

BACKGROUND 

Since September 1, 1990, the National Practitioner Data Bank (hereafter referred to as the


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


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


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


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


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


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


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


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


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


dentists, and other health care practitioners.


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


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


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


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


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


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


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


without the reports.


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


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


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


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


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


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


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


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


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


Appendix A gives details of our methodology.


i 
FINDINGS 

USEFULNESS TO HOSPITMS: Hospital officials found a much higher propoti”on of 

reports to be useful; however, a much smaller propoti”on of reports provided 

inforndon that was previously unknown to hospital staff. 

� The proportion of reports that hospital officials consider useful increased from 

58 percent in the period from September 1, 1990 to March 19, 1992 (period A) to 

83 percent in the period from March 20, 1992 to February 25, 1994 (period B). 

� Response time, which had been very problematic in the early part of period A, 

improved significantly toward the end of period A; that improvement was 

maintained throughout period B. The Data Bank’s electronic querying process, 

which was begun in period B, allowed hospitals to receive reports much more 

quickly than if they submitted queries by mail. 

� The proportion of reports that provided information previously unknown to hospital 

staffs declined from 40 percent in period A to 28 percent in period B. 

� In neither period did hospital officials see accuracy of reporting to be a large 

problem. 

� The reasons hospital officials found reports useful or not useful remained largely 

unchanged. The most commonly cited reason in both periods for the reports being 

useful was that they coni%rned information from other sources; the most commonly 

cited reason in both periods for the reports not being useful was that they 

duplicated information available elsewhere. 

� (Measured only in period B.) Seventy-seven percent of our respondents felt that 

responses from the Data Bank that listed no adverse information were at least 

somewhat useful to them. Seventy-one percent found it worthwhile to query the 

Data Bank about all practitioners, as the current law requires. 

IMPACT ON DECISIONS: In both periods, hospitals seldom made different privileging 

decisions than they would have made without the Data Bank reports. 

� In period A, according to hospital officials, if hospitals had not received the Data 

Bank reports, their privileging decisions would have been different 1 percent of the 

time; in period B, thk figure was 2 percent. 

� In period A, 80 percent of reports had little chance to have an impact on hospitals’ 

privileging decisions; in period B, this figure dropped to 75 percent. These reports 

arrived after the decision was made, duplicated available information, or the 

practitioner did not go through the privilege decision process. 

ii 
� Thepercent ofrepofis that could have hadtipact onhospitils' privileging 

decisions butdidnot increased from 19percent (23 reports) inperiod A to 

24 percent (56reports) inperiod B. These arereports that hospitals received 

before they made their privileging decisions and that provided them with new 

information on a practitioner. 

CONCLUSION 

The information in this report contributes to an understanding of the usefidness and impact 

of the Data Bank in hospitals. It reveals that the Data Bank is operating much more 

smoothly than during its early implementation period. Hospital officials are receiving 

reports in a much more timely fashion and they are now much more likely to characterize 

Data Bank information as useful. At the same time, our data reveal that Data Bank 

reports seldom affect privileging decisions of hospitals. 

During this and prior inspections on the Data Bank, we have become ever more aware of 

differing expectations of the Data Bank. Thus, any assessments of the Data Bank’s 

usefulness and impact will depend heavily on how these expectations are expressed and on 

the relative emphasis given to them. In that context, we offer the following concluding 

observations concerning three important expectations about the Data Bank. 

� Data Bank as a Reliable, Centralized Source of Information. In the sense that 

the Data Bank is expected to serve as such a source of information about adverse 

actions and medical malpractice payments, it seems to be working quite well. It is 

a timely, accurate source that is widely regarded as useful--mainly because it 

confirms information available from other (presumably less reliable) sources. 

� Data Bank as a Unique Source of Information. In the sense that the Data Bank is 

expected to serve as a unique source of information--that is, one unavailable 

elsewhere--it clearly has some value. In our sample, 28 percent of the reports 

provided new information to the hospitals. That 28 percent projects to 

25,040 reports providing new information to hospitals over a period of almost 

2 years. 

� Data Bank as a Mechanism to Protect the Public by Preventing Incompetent 

and/or Unprofessional Practitioners from Practicing in Hospitals. Clearly, this is 

the most ambitious and controversial of these expectations. It is also the one most 

difficult to assess without more information. In one sense, the fact that 2 percent 

of reports are having an impact on privileging decisions may seem inappropriately 

low. It may suggest that hospitals are overly reluctant to take adverse actions 

against incompetent and/or unprofessional practitioners. 

Yet, to the extent that only a small percent of practitioners are unfit to practice, 

one may argue that nothing is necessarily inappropriate about 2 percent of reports, 

which projects to 1,520 reports over a period of almost 2 years, having an impact 

on privileging decisions. These 1,520 reports involve hundreds of practitioners 

111

and affect thousands of patients they serve. Finally, it is important to recognize 

that the very existence of the Data Bank may deter some unfit practitioners from 

even applying to hospitals for practice privileges and may encourage other 

practitioners to be more forthcoming in the applications they submit for hospital 

privileges. 

COMMENTS ON THE DRAITI’REPORT 

We solicited and received comments on the draft report from the Public Health Service 

(PHS), the Assistant Secretary for Planning and Evaluation (ASPE), the American 

Hospital Association (AHA), and the American Medical Association (AMA). Their 

comments appear in fill in appendix C. Below we summarize their comments, and, in 

italics, our responses. 

PHS Comments 

The PHS expressed appreciation for our inquiry and indicated that the report would be 

helpful. It called for one minor change in the background section of the report where we 

explain the Data Bank law. We appreciate the positive response f?om PHS. We made the 

change requested. 

ASPE Comments 

The ASPE supported the purpose of our inquiry and noted that the methodology seemed to


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


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


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


one’s assessments of usefulness and impact will depend heavily on one’s expectations of


the Data Bank.


AHA Comments 

The AHA found it “encouraging” that hospital respondents regarded Data Bank reports to 

be more usefid and timely than during our prior survey period. At the same time, it 

expressed concern that the supplemental role of the Data Bank in hospital credentialing 

and privileging efforts may come at “too high a price. ” How one assesses the 

pefonnance of the Data Bank, as we noted above, is likely to depend heavily on one’s 

expectations of it in the first place. Our intention, in focusing on the usefulness and 

impact of Data Bank reports, was to contribute to such assessments whatever one’s 

starting place. 

AMA Comments 

The AMA expressed considerable concern about the cost-effectiveness of the Data Bank 

and about our report. As with our prior report, it found this one misleading in that it 

focused on the universe of matches rather than the much larger universe of queries to the 

iv 
Data Bank. It also found misleading our findings that (1) 77 percent of the hospital 

respondents found Data Bank responses with no adverse information about a practitioner 

to be at least somewhat useful and (2) 71 percent found it worthwhile to query the Data 

Bank for all practitioners, as the law requires. It specified that the Likert scale we used 

for the former finding and the yes-no format for the latter accounted for what “may have 

been predictable” responses. Finally, it commented that we gave insufficient attention to 

our draft report finding that 5 percent of hospital respondents found the Data Bank match 

reports sent them to be incomplete. 

We disagree with the Ah4A on the value of focusing on matches. In our prior report and 

in this one, we focused on matches to provide discrete, practical feedback on the 

information actually provided to hospitals by the Data Bank. With respect to the abovenoted findings, we note that the 77percent of respondents who regarded the Data Bank 

responses with no adverse information to be at least “somewhat useful” included 

26 percent who regarded it as “extremely or very usejl.d” and 27percent as “moderately 

usefil. “ The use of a yes-no format to record an overall assessment of the Data Bank is, 

we believe, an unbiased approach toward obtaining a basically positive or negative 

reaction. Finally, we agreed with the AMA that if 5 percent of Data Bank repotis were 

incomplete that would be significant information warranting immediate attention. 

Accordingly, we conducted a follow-up inquiry, and, as we note on page 7, found that all 

of the reports initially cited as incomplete were explainable as timing issues or as 

respondent errors. None involved actual nonrepotiing to the Data Bank. 

v 
TABLE OF CONTENTS 

PAGE 

EXECUTIVE SUMMARY


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


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


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


�Impact onDecisiom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13


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


APPENDICES


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


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


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


D: Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D-1

INTRODUCTION 

PURPOSE 

To update an assessment of the usefulness and impact of information in the National 

Practitioner Data Bank to hospitals. 

BACKGROUND 

Since September 1, 1990, the National Practitioner Data Bank has received and 

maintained records of malpractice payments and adverse actions taken by hospitals, other 

health care entities, licensing boards, and professional societies against licensed health 

care practitioners. It provides hospitals and other health care entities with information 

relating to the professional competence and conduct of physicians, dentists, and other 

health care practitioners. The Data Bank was established by Title IV of the Health Care 

Quality Improvement Act of 1986 (P.L. 99-660), as amended, and is fi.mded by user fees. 

It is operated by the Unisys Corporation under contract to the Health Resources and 

Services Administration (HRSA) of the Public Health Service (PHS). 

Hospitals are required to request information from the Data Bank about every physician 

and dentist who applies for appointment. Hospitals must query about all medical and 

dental staff and other health care practitioners with clinical privileges at least once every 

2 years. They have the option of querying about any practitioner with privileges (or who 

is seeking privileges) at any time. The Data Bank is intended to provide information to 

hospitals to help them make decisions about hiring, granting privileges to, and disciplining 

practitioners. 

As of February 25, 1994, hospitals had received, in response to queries, 108,552 matched 

reports of malpractice payments or adverse actions against physicians, dentists, and other 

health care practitioners. We summarized in detail the profiles of these “matches” in a 

report released in August 1994.1 

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

to hospitals through March 1992.2 That report provided officials in the Department and 

parties interested in the Data Bank with an early evaluation of the Data Bank’s 

effectiveness and utility. In December 1993, the Administrator of HRSA asked us to 

update the information in the February 1993 report using more recent “matches.” He 

cited significant changes in the operation of the Data Bank, a more sizable universe from 

which to draw experiences, and the usefulness of the report to officials in HRSA as 

reasons for his request. We agreed to conduct the study. In addition to this report, we 

are issuing a similar report summarizing the experiences of health maintenance 

organizations, preferred provider organizations, and group practices using Data Bank 

information. 

1

SUMMARY OF FEBRUARY 1993 REPORT 

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

hospitals using a number of measures of usefulness. However, it was very rare for Data 

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

without the reports. Because usefulness of the reports was sharply affected by the 

timeliness of reporting, we recommended that PHS take steps to improve and report upon 

timeliness. We also recommended that the Joint Commission on Accreditation of 

Healthcare Organizations establish guidelines on how quickly hospitals should query after 

receiving privilege applications. We received generally positive comments on a draft of 

the report. The most significant objections to it came from the Assistant Secretary for 

Planning and Evaluation in the U.S. Department of Health and Human Services and the 

American Medical Association (AMA), both of whom objected to our allowing users to 

develop their own definitions of usefulness. The AMA also sharply disagreed with our 

methodology of looking solely at “matches” and not looking at reports that listed no 

information on file. 

METHODOLOGY 

The data presented in this report are derived from a survey of hospitals that received 

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

methodology was intended to allow us to compare that data to the results of the study 

published in February 1993; therefore, the survey questions, whenever possible, were 

asked in an identical manner. We did, however, attempt to address some of the concerns 

raised by our earlier report. Notably, we probed more about why reports did not have 

impact and asked about the usefi.dness of receiving verification that no information is in 

the Data Bank. We sampled 400 matches--instances when a querying hospital received a 

report of a specific incident--from the universe of 89,430 hospital matches from 

March 20, 1992 through February 25, 1994. We received 257 useable responses. Our 

findings can be projected to this universe of matches. Appendix A gives details of our 

methodology and provides information about the reports, practitioners, and hospitals 

included in the study. 

We conducted this study in accordance with the Quali~ Standards for Inspections issued 

by the President’s Council on Integrity and Efficiency. 

2

FINDINGS 

USEFULNESS TO HOSPITWS: Hospital officials found a much higher proportion of 

reports to be useful; however, a much smaller propo~”on of reports provided 

info--on that was previously unknown to hospital staff. 

Whether a report from the Data Bank is useful to a hospital depends on several factors. 

Some factors can be determined objectively, such as whether the report provides new 

information or duplicates other reports, whether it is accurate, and whether the report 

arrives at the hospital in time to be used in the privileging process. Other factors are 

more subjective, such as whether the report is relevant to the reported practitioner’s 

competency and professionalism. Measured by both objective and subjective criteria, the 

Data Bank appears to be continuing to provide useful information to hospitals (see 

figure 1). 

�	 The proportion of reports that hospital officials consider useful increased from 

58 percent in the period from September 1, 1990 to March 19, 1992 (period A) to 

83 percent in the period from March 20, 1992 to February 25, 1994 (period B). 

In period A, there were no statistically significant differences in the percentages of reports


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


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


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


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


differences (see table 1).


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


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


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


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


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


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


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


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


reports and adverse action reports that provided information unavailable elsewhere.


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


�	 Response time, which had been very problematic in the early part of period A, 

improved significantly toward the end of period A; that improvement was 

maintained throughout period B. The Data Bank’s electronic querying process, 

which was begun in period B, allowed hospitals to receive reports much more 

quickly than if they submitted queries by mail. 

3

Percent 

95-

9c85-

8t75-

70-

8t -

80-

55-

50-

45-

4c35-

3t25-

.20JFigure 1 

USEFULNESS OF DATA BANK REPORTS: 

Change From ParbcJA (9/1/90-3/31/92) To Period B (WWfZ-2/25/W 

Propo#on &nsldemd Useful 

ProtMion Priwidng Mnmdon 

Unavallabie Elsewbm 

A B A B 

Soumew Office of Inspector General Surveys of Hospital CMdals. 

Note Perfod k N-142 Responses, Period B N-257 Responsea. 

This improvement in response time helps account for the significant increase in the 

proportion of reports considered to be usefi.d. In period A, officials often reported that 

reports were not usefid because of their lack of timeliness. 

In period A, we found that response time had been steadily improving over the study 

period. The median response time dropped from 123 days to 26 days over the 18 month 

period (measured each quarter). That decline in response time has not continued through 

period B. The median response time was 23 days over period B and has ranged from 

35 days to 14 days, with no particular trend over time. Still the overall improvement in 

response time was dramatic (over the entire period A median response time was 44 days). 

Early in period B, HRSA made software available to hospitals that allowed them to query 

electronically. By the end of the Data Bank’s third year, 47 percent of all queries were 

being submitted electronically .4 In period B, 26 percent of respondents used electronic 

submission. Respondents who queried electronically received responses much faster than 

those who did not (median is 17 days vs. 27 days). Interestingly, they were not more 

likely to find the reports useful (82 percent of those who queried electronically found the 

reports usefi,d while 84 percent of those who did not query electronically found them 

useful). 

4

TABLE 1 

USEFULmS To HOSPITW OF DIFFEREN TYPES 

OF DATA BANK REPORTS 

REPORTS CONSIDERED USEFUL TYPE OF REPORT 

IncidentInvolved 

MalpracticePayment 

Adverse Action 

Amount of MalpracticePayment 

Less Than $30,000 

$30,000 or More 

Type of Adverse Action 

Board LlcensureAction 

Hospital Privileges Action 

Locationof Repofi 

Out-of-State 

In-State 

*Differences are signi#icmt at the 95 percent confidence level. 

period A 

59%(N=74) 

57%(N=9) 

57%(N=16) 

61%(N=25) 

53%(N=20) 

64%(N=21) 

81%(N=72) 

56%(N=11) 

period B 

85%(N=219) * 

67%(N=24) * 

90%(N=72) 

83%(N=147) 

75%(N=16) 

50%(N=8) 

85%(N=97) 

83%(N=146) 

Sources: @ice of Inspector General Surveys of Hospital ojiciak. 

In period A, the proportion of reports arriving before hospitals made final decisions on the 

practitioners involved ranged from 44 percent in the first quarter of the period to 

66 percent in the last. In period B, the proportion of reports arriving prior to the final 

Better respome time accounts for 

decision increased to 83 percent over the entire period. 

some of this improvement, but hospital officials were partly responsible for the low 

proportion of “on-time” arrivals. In period A, 18 percent of all reports did not arrive on 

time because the hospital submitted a query after having made a privileging decision. In 

period B, 6 percent did not submit their Data Bank request until after the decision; 

primarily because they felt they already had sufficient information to make the decision. 

�	 The proportion of reports that provided information previously unknown to hospital 

staffs declined from 40 percent in period A to 28 percent in period B. 

Practitioners themselves and malpractice insurers were more likely to be sources of 

information about incidents in the Data Bank reports in period B than they were in period 

A (see table 2). It is possible that the increase in the proportion of reports that gave 

hospitals information on the practitioners named in the reports provided was in part caused 

by the maturation of the Data Bank. The existence of the Data Bank and practitioner’s 

knowledge of the Data Bank being a source of information for hospitals may make 

practitioners more likely to disclose malpractice payment and adverse action information. 

It is likely that practitioners’ awareness of the Data Bank and of hospitals’ use of the Data 

5 
Bank have grown since the end of Period A. Increased awareness of the Data Bank might 

well be deterring practitioners from withholding information. 

In period A, we cited problems with hospitals not receiving important information from 

their own State’s licensing board and from other hospitals in their State; these problems 

appear to be continuing. In period A, 20 percent of reports originally submitted by 

licensing boards in the hospitils’ own States were the hospitals’ only source of ~owledge 

about the incident and 10 percent of the time hospitals only learned of board actlom from 

sources other than the boards. In period B, 8 percent of reports originally submitted by 

licensing boards in the hospitals’ own States were the only source of knowledge about the 

incident in the hospitals and 33 percent of the time hospitals only learned of board actions 

from sources other than the boards. In both periods A and B, 50 percent of Data Ba& 

re~orts . on clinical privilege actions taken by other hospitals provided information

otherwise unavailable. 

SOURCES OF 

SOURCE 

Practitioner 

State LicensingBoard In-State 

State LicensingBoard Out-of-State 

MalpracticeInsurer In-State 

MalpracticeInsurer Out-of-State 

Hospital In-State 

HospitalOut-of-State 

ProfessionalSocietyIn-State 

ProfessionalSocietyOut-of-State 

Other In-State 

Other Out-of-State 

TABLE 2 

DATA BANK INFORMATION 

PERCENT OFREPORTS HOSPITALOFFICIALS 

WEREAWAREOFFROMEACHSOURCE 

PERIOD A: PERIOD B: 

(9/1/90-3/18/92) (3/19/92-2/25/94) 

(N= 142) (N=247) 

53% 60% 

9% 7% 

<1% 1% 

9% 14% 

o% 2% 

4% 5% 

2% 2% 

<1% 1% 

o% <1% 

7% 7% 

o% 1% 

Note: Propo~ions will not add to 100% because hospitals could have more than one source of inforwtion. 

Sources: Ofjice of Inspector General Surveys of Hospital @icials. 

The surprising finding from Period A that hospitals seemed more likely to be aware of 

malpractice payments and adverse actions occurring in other States than of payments and 

actions in their own States was not true in Period B. In period A, hospitals were aware of 

6 
information contained in 85 percent of reports from other States, but in only 55 percent of 

reports from their own States. In period B, hospitals were aware of information contained 

in 70 percent of reports from other States and 72 percent of reports from their own States. 

�	 In neither period did hospital officials see accuracy of reporting to be a large 

problem. 

For period A, we found that no hospital in our sample responded that the Data Bank 

report it received was inaccurate. In period B, no hospital determined, after making 

additional inquiries, that the information in the Data Bank report was inaccurate. 

In our draft report, we had indicated that there was growing evidence that the Data Bank 

is not reporting to hospitals all the information it should. We based that on the finding 

that in period B 12 hospitals (almost 5 percent of all respondents) indicated that the 

responses received from the Data Bank were incomplete (i.e., that the Data Bank should 

have had additional information on the practitioner in question). In period A, by contrast, 

only one hospital said that the Data Bank response was incomplete. 

Upon further inquiry since the issuance of our draft report, we determined that none of 

the Data Bank reports cited by the 12 hospitals as being incomplete during period B 

remain incomplete today. Moreover, we found that all of the Data Bank reports identified 

by the hospitals as incomplete could be explained as errors by the hospital respondents or 

as timing issues (wherein a hospital learned of a malpractice payment or disciplinary 

actions from another source before it was sent to the Data Bank). We found no instances 

of nonreporting to the Data Bank. 

�	 The reasons hospital officials found reports useful or not usefi.d remained largely 

unchanged. In both periods, the most commonly cited reason for the reports being 

useful was that they confirmed information from other sources; the most commonly 

cited reason in both periods for the reports not being useful was that they 

duplicated information available elsewhere. 

Table 3 demonstrates the differences between period A and period B in the reasons 

hospitals considered reports useful and not useful. It is clear that hospitals find the 

reports useful in large part because they confirm information available elsewhere. It is 

likely that if they found the other sources very reliable and trustworthy, they would not 

find the Data Bank information useft.d because it was duplicative.5 The fact that many 

find the reports useful because they are confirmatory may indicate that the Data Bank is 

filling a need for a reliable source of information. In fact, of the reports that told 

hospitals about incidents they were aware of from other sources, 15 percent were 

inconsistent with those other sources. Yet, as we already noted, no Data Bank report was 

found to be inaccurate upon further inquiry. The Data Bank, while it may provide 

information available elsewhere, is a consistently accurate source of information. This 

gives us key insights into how hospitals rely upon the Data Bank and why reports are 

useful to so many hospitals. 

7

�	 (Measured only in period B.) Seventy-seven percent of our respondents felt that 

responses from the Data Bank that listed no adverse information were at least 

somewhat useful to them. Seventy-one percent found it worthwhile to query the 

Data Bank about all practitioners, as the current law requires. 

In period B, we asked two questions we did not ask in period A that help assess the 

usefulness of the Data Bank. The first asked “How useful to you are responses from the 

Data Bank that do not list any adverse information?” (Choices were “extremely useful, ” 

“very useful, “ “moderately useful, ” “somewhat usefi.d,” or “not useful.”) Among the 

77 percent who answered that the reports were useful, the great majority designated the 

“moderately” or “somewhat” useful categories. 

The second question we asked was “All things considered, do you feel it is worthwhile to 

query the Data Bank about all practitioners in your hospital as current law requires?” 

About 71 percent of respondents said yes. Officials felt the information was worthwhile 

for all types of queries: that it was confhnatory, that it was a reliable source of 

information, that it was a source of information when practitioners failed to notify the 

hospital of incidents, and that it was national in scope. Officials who felt it was not 

worthwhile to query frequently felt that the expense of time and money was not worth it, 

that they can use other sources easily to get the same information, and that there is 

incomplete or insufficient information in the Data Bank. 

8

TABLE 3 

REASONS OFFICIALS CONSIDERED REPORTS USEFUL AND NOT USEFUL 

PROPORTION OFREPORTS THATHOSPITAL

OFFICIALS CONSIDERED USEFUL

Period A: Period B: 

REASON 1 CONSIDERED USEFUL (9/1/90-3/18/92) (3/20/92-2/25194) 

Number of reports Number of reports 

considered considered 

useful=83 usefil =203 

Confirmed Other Available Information 60% 65% 

Helped Judge Practitioner’sCompetency 37% 32% 

Provided Information UnavailableElsewhere 30% 24% 

Helped Judge Practitioner’s Professionalism 22% 25% 

Other Reason 10% 6% 

PROPORTION OFREPORTS THATHOSPITAL

OFFICIALS DIDNOTCONSIDER USEFUL

Period A: Period B: 

REASON NOTCONSIDERED USEFUL (9/1/90-3/18/92) (3/20192-2/25/94) 

Number of reports Number of reports 

not considered not considered 

usejid=55 use@l=40 

InformationAvailable Elsewhere 52% 75% 

Information Did Not Help Judge Competencyor 63% 45% 

Professionalism 

Report Not Timely 54% 18% 

Report Inaccurate <1% 5% 

Other Reason 19% 15% 

Note: In period A, 58 percent of reports were found usefid and in period B, 83 percent were found usejid. 

Proportions in this table will not add to 100% because hospitals could have more than one reason. 

Sources: (@e of Inspector General Surveys of Hospital 0j7cials. 

9

IMPACT ON DECISIONS: In both periods, hospitals seldom made different privileging 

decisions than they would have made without the Data Bank reports. 

The impact that receiving information from the Data Bank has on hospitals can be 

characterized in several ways. Impact may include giving hospital administrators 

confidence that they have complete information about their medical staffs. It may include 

adding information to practitioners’ files that could be used in the future should questions 

arise. But Data Bank reports can have their most direct impact by affecting the outcome 

of decisions on practitioners who have just applied for new or continued hospital 

privileges. For this reason, we asked hospitals (in both periods A and B) the following 

question: Would your decision regarding the practitioner have been different if you had 

not received the Data Bank report? Because our measurement of impact focused on the 

privileges decisions, we did not include in this analysis any situations when decisions were 

still pending. In period A, 16 percent of Data Bank reports involved practitioners for 

whom the hospitals’ privileging decisions were still pending at the time of our survey; in 

period B, this figure was 8 percent. 

Figure 2 demonstrates how the proportions of reports that had impact, no potential for 

impact, and potential for impact changed over the two periods. 

In period A, according to hospital officials, if hospitals had not received the Data 

Ba& reports, their privileging decisions would have been different 1 percent of the 

time; in period B, this figure was 2 percent. 

In period B, of the 236 officials who answered the question, 4 said their decisions would 

have been different. One hospital terminated privileges immediately upon receiving the 

Data Bank report (which reported a voluntary surrender of privileges while under, or to 

avoid, investigation for incompetence, malpractice, or negligence). Another hospital 

reported that the practitioner withdrew his application, but it would have denied privileges 

based on the report (which reported conditional reinstatement of privileges at another 

hospital). A third hospital made a decision to grant temporary privileges prior to 

receiving the Data Bank response, but would not have granted them had it known the 

information in the response (which described a $50,000 surgery-related malpractice 

payment). A fourth hospital temporarily suspended and investigated a physician based on 

the Data Bank report (which detailed a $95,000 anesthesia-related malpractice payment); 

the hospital eventually granted privileges to the physician. 

In period B, we asked a follow-up question about whether the report, if it did not cause 

the officials to make a different decision, made the officials feel more confident, less 

confident, or no different. Of the 188 respondents, only 7 felt the report made them less 

confident and 49 (26 percent) felt the reports made them more confident about their 

decisions. In all but two of these cases, the practitioner involved was granted full 

privileges. This is, therefore, an unexpected result. One would expect that receiving 

adverse information would make decision makers less confident about granting privileges. 

10

� In period A, 80percent ofrepotis hadlitile chance tohavean impact onhospi~ls' 

privileging decisions; inperiod B,thisfigure dropped to75 percent. These reports 

arrived after the decision was made, duplicated available information, or the 

practitioner did not go through the privilege decision process. 

In period A, that 80 percent (97 reports) consisted of 

10 reports that named practitioners who did not go through the privilege decision 

process. These practitioners either withdrew their applications or requested only 

temporary privileges. 

46 reports that were not received prior to hospitals making decisions. For 

22 reports, the hospitals did not query the Data Bank until after the decisions and 

for 24 reports, they queried in advance of the decisions. 

41 reports that, though received by hospitals before credentialing decisions were 

made, provided only information already known to the hospitals. 

In period B, the 75 percent (176 reports) consisted of 

16 reports that named practitioners who did not go through the privilege decision 

process. 

27 reports that were not received prior to hospitals making decisions. 

133 reports that, though received by hospitals before decisions were made, 

provided only information already known to the hospitals. 

In period B, we also asked officials why the reports did not lead them to make privileging 

decisions they would not have made without the reports. Of responding officials, 

55 percent said at least part of the reason the reports did not have impact was that the 

reports did not indicate a problem warranting restricting or denying privileges; 54 percent 

cited already knowing about the information as a reason; 8 percent cited not receiving the 

report in time to affect the decision, and 3 percent said they would have restricted or 

denied privileges anyway. 

The percent of reports that could have had impact on hospitals’ privileging 

decisions but did not increased from 19 percent (23 reports) in period A to 

24 percent (56 reports) in period B. These are reports that hospitals received 

before they made their privileging decisions and that provided them with new 

information on a practitioner. 

In period A, we did not ask officials who responded that the reports did not alter their 

credentialing decisions why they did not. However, we analyzed whether or not they 

found the reports useful and why. In period A, about half of the reports that arrived 

before hospitals’ decisions were finalized and contained information that neither the 

11 

� 
Figure 2 

IMPACT OF DATA BANK REPORTS: 

CHANGE FROM PERIOD A TO PERIOD B 

E 

o T 

PERIOD A PERIOD B 

(n-142) (n-257) 

Data Perbd A-9/l19CW8/92, Perfod 6-3/19/92-2/25/94.


Sources OffIce of Inspector Wmral Sutveys of Hosp”ti CMcials.


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


practitioner nor any other sources had provided were judged not useful. Most often these 

reports were considered not useful because they could not help judge competency or 

professionalism. The other half were considered useful. In period B, only 11 percent of 

the reports that arrived before hospitals’ decisions were finalized and contained 

information that neither the practitioner nor any other sources had provided were judged 

not useful. The primary reason these reports were judged not useful was again because 

they did not help judge the practitioner’s competency or professionalism. 

ln period B, we asked officials who said that their privileging decisions would not have 

been different without the Data Bank report why their decisions would not have been 

different. Of the reports that arrived prior to the final decisions and that contained 

information not available from other sources, officials said 64 percent did not indicate a 

problem that warranted restricting or denying privileges. No other reason had a frequency 

of more than 4 (7 percent). b One official said that the hospital restricted or denied 

privileges anyway. 

12

CONCLUSION 

The information in this report contributes to an understanding of the usefulness and impact 

of the Data Bank in hospitals. It reveals that the Data Bank is operating much more 

smoothly than during its early implementation period. Hospital officials are receiving 

reports in a much more timely fashion and they are now much more likely to characterize 

Data Bank information as useful. At the same time, our data reveal that Data Bank 

reports seldom affect privileging decisions of hospitals. 

During this and prior inspections on the Data Bank, we have become ever more aware of 

differing expectations of the Data Bank. Thus, any assessments of the Data Bank’s 

usefulness and impact will depend heavily on how these expectations are expressed and on 

the relative emphasis given to them. In that context, we offer the following concluding 

observations concerning three important expectations about the Data Bank. 

�	 Data Bank as a Reliable, Centralized Source of Information. In the sense that 

the Data Bank is expected to serve as such a source of information about adverse 

actions and medical malpractice payments, it seems to be working quite well. It is 

a timely, accurate source that is widely regarded as useftd--mainly because it 

confh-ms information available from other (presumably less reliable) sources. 

�	 Data Bank as a Unique Source of Information. In the sense that the Dab Bank is 

expected to serve as a unique source of information--that is, one unavailable 

elsewhere--it clearly has some value. In our sample, 28 percent of the reports 

provided new information to the hospitals. That 28 percent projects to 

25,040 reports providing new information to hospitals over a period of almost 

2 years7. 

�	 Data Bank as a Mechanism to Protect the Public by Preventing Incompetent 

andlor Unprofessional Practitioners from Practicing in Hospitals. Clearly, this is 

the most ambitious and controversial of these expectations. It is also the one most 

difficult to assess without more information. In one sense, the fact that 2 percent 

of reports are having an impact on privileging decisions may seem inappropriately 

low. It may suggest that hospitals are overly reluctant to take adverse actions 

against incompetent and/or unprofessional practitioners. 

Yet, to the extent that only a small percent of practitioners are unfit to practice, 

one may argue that nothing is necessarily inappropriate about 2 percent of reports, 

which projects to 1,520 reports over a period of almost 2 years8, having an impact 

on privileging decisions. These 1,520 reports involve hundreds of practitioners 

and affect thousands of patients served by these practitioners. Finally, it is 

important to recognize that the very existence of the Data Bank may deter some 

unfit practitioners from even applying to hospitals for practice privileges and may 

encourage other practitioners to be more forthcoming in the applications they 

submit for hospital privileges. 

13 
COMMENTS OF THE DRAFT REPORT 

We solicited and received comments on the draft report from the Public Health Service 

(PHS), the Assistant Secretary for Planning and Evaluation (ASPE), the American 

Hospital Association (AHA), and the American Medical Association (AMA). We include 

the complete text of their comments in appendix C. Below we summarize the comments 

of the respondents and, in italics, offer our responses. 

PHS COMMENTS 

The PHS noted our efforts in working cooperatively with the staff in the Health Resources 

and Services Administration and indicated that the report “will be helpful in administering 

the program. ” It called for one minor change in the background section of the report 

where we explain the Data Bank law. 

We appreciate the positive response from PHS. We made the change requested. 

ASPE COMMENTS 

The ASPE commented that the purpose of our inquiry was “commendable” and that the 

survey methodology seemed “appropriate.” It added, however, that the conclusions we 

drew “are a matter of interpretation and that the findings of the report could be used to 

support conclusions other than those supported by the OIG. ” It recommended that we 

discuss why we conclude that the Data Bank is useful when some evidence in the report 

might be used to reach a contrary conclusion. 

We did not draw the conclusion, as ASPE stated, that the Data Bank is usefil. In our


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


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


assessments of useji.dness and impact will depend heavily on one’s expectations of the Data


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


observations concerning each of three sets of expectations.


AHA COMMENTS 

The AHA indicated that it was “encouraging” that hospitals found Data Bank reports to be 

more useful and timely than during our prior survey period. However, it raised concern 

that the proportion of reports providing information previously unknown to hospitals has 

declined. In elaborating on that concern, it suggested that the supplemental role of the 

Data Bank in hospital credentialing and privileging efforts may come at “too high a 

price. ” It asked: “...is the confirmatory information worth the significant administrative 

and financial burdens the Data Bank imposes on hospitals and other Data Bank users?” 

We hope that the survey data we provided on use@lness and impact will help readers 

answer that question for themselves. As we noted in our concluding section, one’s 

14 
assessment of the value of the Data Bank will depend largely on one’s expectations of it in 

the jirst place. Further, on the mutter of the declining propotiion of Data Bank reports 

providing new information to the hospitals, we think it is quite possible, as we noted in the 

report, that the practitioners’ increased awareness of the Data Bank may well make them 

more likely to disclose any malpractice payments or adverse actions concerning themselves 

before the hospital gets the information from the Data Bank. Thus, it is not just that the 

Data Bank provides “confirmatory” information as xlHA noted, but that it may also serve 

as a trigger for information that may not otherwise reach the hospitals. 

AMA COMMENTS 

The AMA, like the AHA, raised concerns about the cost effectiveness of the Data Bank. 

But it also raised a number of specific concerns about our report. 

It’s core concern with our report (as with our parallel prior report of February 1993) is 

that it focuses on the universe of matches rather than queries. In so doing, the AMA 

indicated, we end up offering misleading conclusions about usefulness and impact because 

matches represent only about 4 percent of all hospital queries to the Data Bank. Along 

this line, the AMA called for us to include information in the report on the number of 

queries. It specifically noted that our statement that “as of February 25, 1994, hospitals 

had received in response to queries, 108,552 reports of malpractice and adverse actions” 

was incorrect. It added “that the word ‘matched’ must be inserted between ‘108,552’ and 

‘reports’ to reinforce the fact that this report is only looking at approximately 4.4 percent 

of the universe of queries. ” 

The AMA added that in our report we attempted to justi~ the low match rate and the low 

impact on credentialing. It said that we did this by reporting that 77 percent of the 

respondents found that Data Bank reports with no adverse information on a practitioner 

were at least somewhat useful to them and that 71 percent found it worthwhile to query 

the Data Bank for all practitioners as the law requires. It commented that the former 

statistic “may have been predictable because the Likert scale was skewed in favor of 

providing a positive response” and the latter because it simply elicited a yes or no 

response. Forty-two percent of those who explained their response, it said, offered 

critical judgments of the Data Bank. 

In addition, the AMA commented that (1) our report would be strengthened if we 

analyzed matched reports on the basis of the reason hospitals queried the Data Bank and 

(2) our draft report gave insufficient attention to the finding that 5 percent of hospitals 

found that the Data Bank match reports provided them were incomplete. This significant 

finding, the AMA said, should be included in the executive summary of our report and 

should be addressed immediately by PHS. 

In 1992, when we jirst began our inquiries about the Data Bank, we decided, afier 

consultation with various parties, to focus on the usejidness and impact of the information 

in the Data Bank, as opposed to the overall utility of the Data Bank. We determined that 

such a focus would provide more discrete and practical information about what the Data 

15 
Bank actually produces and in so doing could contribute to broader assessments of the 

Data Bank. We repeated that approach for this report 10 allow for comparative 

assessments of the usefulness and impact of Data Bank reports over time. We disagree 

with the xlM4 over the value of this approach. 

In response to concerns expressed by MA and some others about our prior inquiry 

(concerning period A), we added the following questions this time: (1) “How usefid to you 

are responses that do not list any adverse information?” and (2) “All things considered, 

do you feel it is worthwhile to query the Data Bank about all practitioners in your hospital 

as current law requires?” We believe the answers to these questions o~er usejid 

perspectives of key respondents on the overall utiliy of the Data Bank. To MIA’s critique 

that the results we report on the first question may overstate the positive by reporting that 

77percent of the respondents found the information “at least somewhat use@l, “we note 

that total includes 26 percent who regarded it as “extremely or very usefil” and 

27percent as “moderately usefid. “ To AMA’s critique that the results of the second are 

predictable because of the yes-no response format, we respond thut the simple format was 

an unbiased one allowing for the respondent to express a basically positive or negative 

response. 

In response to the MA’s suggestion, we did clarl~ in our background section that the 

Data Bank reports we refer to are “matched” repotis. However, we did not provide 

additional information as the M requested. In an August report entitled, “National 

Practitioner Data Bank: Profile of Matches Update (OEI-01-94-00031), “we offer 

extensive data that provide considerable perspective on Data Bank matches. 

We agreed with the AMA that if 5 percent of the reports to the Data Bank were, in fact, 

incomplete, that would be a sigrdjlcant matter warranting immediate attention. For that 

reason, we conducted a follow-up inquiry and as we pointed out on page 7, all of the 

reports cited by hospital respondents as “incomplete” turned out to be explainable as 

timing issues or as respondent errors. None involved actual nonrepotiing to the Data 

Bank. 

Additional analysis, as MA called for, on the reasons for hospitals querying the Data 

Bank could be of some value, but goes beyond what we can undertake at this time. 

16

APPENDIX A 

METHODOLOGY 

For a summary of our methodology for the initial study period @eriod A--9/l/9O through 

3/19/92), see Appendix A of our report entitled “National Practitioner Data Bank: 

Use@lness and Impact of Repotis to Hospitals” (February 1993). 

We collected the data presented in this report for period B (March 20, 1992 through 

February 25, 1994) through a mail survey of hospitals conducted from May to July 1994. 

We drew our sample from the universe of all Data Bank matches involving hospitals 

between March 20, 1992 and February 25, 1994. A match is a pairing of a report and a 

query to the Data Bank that name the same practitioner. We requested and received a 

computer file containing records of all Data Bank queries and reports that identified the 

same practitioner. We restructured and analyzed the data using SAS@Release 6.08 on a 

mainframe computer and Version 6.04 of the SAS@System for Personal Computers. 

We drew a simple random sample of 400 matches from the universe of 89,430 matches. 

This differs from the sampling methodology we used in period A, which involved a 

stratified random sample of 200 matches. We increased the sample size to lend more 

credibility to our findings and to tighten contldence intervals. We choose not to stratify 

the sample because we did find significant differences on any key measure by the 

stratification variable (type of report). 

In May 1994, we mailed a questionnaire about each report to the hospital involved. There 

were 372 hospitals that received questionnaires; 22 hospitals were each sent questions on 

2 different practitioners (1 of those hospitals received a total of 3 questionnaires--1 for 

1 practitioner and 2 for different matches for another practitioner); 1 was sent 

questionnaires on 3 different practitioners, and 1 was sent questiomaires on 4 different 

practitioners. We followed this with a second mailing to nonrespondents. All responses 

used in the analysis were received by July 20, 1994. Appendix B shows the questionnaire 

and simple frequencies. 

Questionnaires were addressed to the person whose name appeared on the original query 

to the Data Bank. Most respondents held the position of medical staff coordinator or the 

equivalent. A few respondents were the chief executive officers of their hospitals. 

Our response rate was 64 percent. Most of the responses (89.5 percent) concerned 

malpractice reports; 10.5 percent concerned adverse action reports. Overall, malpractice 

matches accounted for 89 percent of the universe of matches, so the distribution of report 

types in our response was as expected. 

Sixty-nine percent of the respondents queried the Data Bank because of mandatory 

A-1

two-year review requirements, 29 percent queried on initial privileging or employment 

applications, and 2 percent queried for professional review purposes. Of the 27 responses 

based on adverse actions, 63 percent were State licensing board actions and 47 percent 

were hospital clinical privileges actions, Ninety-three percent of the respondents queried 

about physicians (the other practitioners were dentists, podiatrists, and nurse anesthetists. ) 

The specialties of the physicians are listed in table A. 

There were 248 hospitals represented in the responses. Of the 22 hospitals that had been 

sent questionnaires about 2 practitioners, 10 responded, but 1 responded to only 

1 questionnaire and the 1 that had received 3 questionnaires (2 for 1 practitioner) returned 

2 questionnaires (1 for each practitioner). Of the 2 hospitals that had been sent 

questionnaires about more than 2 practitioners, neither returned any questionnaires. 

Unless otherwise noted, survey results presented as percentages have a margin of error of 

approximately 5 percent at the 95 percent confidence level. Confidence intervals for 

statistics cited for period B in the body of the report are summarized in table B. 

A-2

---

TABLE A 

TYPES OF PRACTITIONER 

TE OF PRACTITIONER NUMBER OF MATCHES PERCENTAGEOF MATCHES 

)TAL 

IYSICIANS 

Obstetrics and Gynecology


General Surgery


Family Medicine


Orthopedic Medicine


Internal Medicine


Missing


Emergency Medicine


Neurological Surgery


Eye, Ear, Nose, and Throat


Plastic Surgery


Urology


General Medicine


Anesthesiology


Ophthalmology


Cardiology


Pulmonary Medicine


Psychiatry


Oncology


Gastroenterology


Osteopathic Gynecology


Radiology


Cardiac Surgery


Dermatology


Thoracic Surgery


Occupational Medicine


Radiotherapy


Pathology


DENTISTS and ORAL 

SURGEONS 

PODIATRISTS 

NURSE ANESTHETISTS 

257 100.0 

239 92.6 

4.-

30 11. / 

29 11.2 

22 8.6 

21 8.3 

17 6.6 

10 3.9 

9 3.5 

9 3.5 

9 3.5 

9 3.5 

8 3.1 

7 2.7 

7 2.7 

6 2.3 

5 1.9 

4 1.6 

4 1.6 

3 1.2 

3 1.2 

3 1.2 

3 1.2 

2 0.8 

2 0.8 

1 0.4 

1 0.4 

1 0.4 

1 (-).4 1 — 

11 4.3 

7 2.7 

1 0.4 

I Source: (?ftice of InspectorGeneralSurveyof HospitalOf@als, May - July 1994 

A-3

TABLE B 

CONFIDENCE INTERVALS FOR KEY STATISTICS 

Description Page Value	 95 Percent Confidence 

Interval 

(+ or-) 

Proportion of reuorts considered useful 3 83.2 percent 4.7 percent 

Proportion of respondents rating licensing board actions 3 69.6 percent 5.8 percent 

extremely useful 

Proportion of respondents rating hospital actions extremely 3 68.3 percent 5.8 percent 

useful 

Proportion of respondents rating malpractice payments 3 39.8 percent 6.1 percent 

extremely useful 

Proportion of reports that provided information previously 4 28.0 percent 5.6 percent 

unknown 

Proportion of time learned of board actions from sources 5 33.3 percent 26.7 percent 

other than boarrl 

Proportion of reports on board actions that provided 5 8.3 percent 15.6 percent 

information previously unknown 

Proportion of reports on hospiral actions that provided 5 50.0 percent 30.1 percent 

information previously unknown 

Proportion of reports from other States hospitals were aware 5 69.7 percent 9.1 percent 

of 

Proportion of reports from own States hospitaIs were aware of 5 71.6 percent 7.3 percent 

Proportion of respondents indicating report was incomplete 6 4.7 percent 2.6 percent 

Proportion of respondents using electronic query. 6 25.6 percent 5.6 percent 

Proportion of reports that used electronic query and were 6 81.7 percent 9.8 percent 

found usetid 

Proportion of reports that did not use electronic query and 6 83.5 percent 5.6 percent 

were found usefil 

Proportion of reports that arrived prior to tlmal decision 7 83.2 percent 5.4 percent 

Proportion of reports that were not “on-time” because of a 7 5.8 percent 2.9 percent 

late query 

Proportion of reports that told hospitals about information 7 14.5 percent 5.4 percent 

they were aware of and was not consistent with it 

Proportion of respondents who find it worthwhile to query for 7 71.1 percent 5.8 percent 

all practitioners 

Proportion of respondents who find reports that do not list 7 47.2 percent 6.2 percent 

adverse information somewhat or not useful 

Proportion of respondents who fmd reports that do not list 7 26.0 percent 5.4 percent 

adverse information extremely or very useful 

Proportion of respondents who find reports that do not list 7 26.8 percent 5.5 percent 

adverse information moderately useful 

Proportion of reports with decisions pending 9 7.8 percent 3.3 percent 

Propordon of reports that made a difference in a decision 9 1.7 percent 1.6 percent 

A-4 
TABLE B 

CONFIDENCE INTERVALS FOR KEY STATISTICS 

Description Page Value	 95 Percent Cotildence 

Interval 

(+ or -) 

Proportion ofreports that made respondent more cotildent 9 26.1 percent 6.3 percent 

about a decision 

Proportion of reports that had little chance of impact 10 74.6 percent 5.6 percent 

Proportion of reports that practitioner did not go through 10 6,8 percent 3.2 percent 

credentialing process 

Proportion of reports not received prior to decision 10 11.4 percent 4.1 percent 

Proportion of reports provided information already know 10 56.4 percent 6.3 percent 

(though received “on-time”) 

Proportion of reports where respondents said at least part of 10 55.8 percent 6.5 percent 

the reason for no impact was that the reports did not warrant 

restricting or denying privileges 

Proportion of reports where respondents said at least part of 10 54.7 percent 6.5 percent 

the reason for no impact was that the reports gave them 

inforrnationthey afready were aware of 

Proportion of reports where respondents said at least part of 10 7.6 percent 3.5 percent 

the reason for no impact was that the reports did not arrive in 

time 

Proportion of reports where respondents said at least part of 10 3.1 percent 2.3 percent 

the reason for no impact was that they denied or restricted 

privileges anyway 

Propordon of reporls that could have had impact but did not 10 23.7 percent 5.4 percent 

Proportion of reports that could have had impact and were 11 12.0 percent 9.0 percent 

judged not useful 

Proportion of reports that could have had impact and yet did 11 76.6 percent 12.1 percent 

not indicate a problem warranting a change in privileges 

A-5

APPENDIX B 

SUMMARY OF HOSPITALS’ RESPONSES TO OIG MAIL SURVEY 

B-1 
not 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

USE AND UTILITY OF THE


NATIONAL PRACTITIONER DATA BANK


NOTE: The first 33 questionsin this survey concernthe case of PractitionerA, whose identity is given on the 

last page of this questionnaire. Unless otherwise specified, please confineyour responsesto your knowledge 

of the particular practitioner and event referred to on that page. 

BASIC FACTS AND CHRONOLOGY 

1 What is Practitioner A’s specialty? 31 d~ferent specialtiesrepresented 1 

2 On what date did Practitioner A sign an application 2 

requesting privileges (either new or continued) at your m“de range of dates 

hospital? 

3 On what date did you request information about 3 

Practitioner A from the National Practitioner Data un”derange of dates 

Bank? 

4 Did you request information about Practitioner A Yes:61 

using electronic querying methods (QPRAC)? No:177 

Missing: 19 

4 

5 On what date did you receive a response from the 5 

Dab Bank? (Write “~” ~YOU have not Yet ‘eceived ~ w-de ~ad rangere~eiyed of dates a

a response.) response yet 

6 On what date did the hospital board make its initial wide range of dates 6 

decision regarding Practitioner A’s privileges? write ~e~~~~dfifl 

“PENDING” if board’s initial decision has not yet 

been made, then skip to 16.) 

7 (If YOU made your decision about Practitioner A prior 15 queried after 7 

to receiving information from the Data Bank.) Why having made a 

decision did you make your decision about Practitioner A’s 

privileges prior to receiving information in response to 

the request? 

a The response took too long to arrive. yes: 0 a 

b We had sufficient information already to make the Yes:12 b 

decision. 

c This request was made outside of our credentialing Yes:4 c 

process. It was made for the following reason: 

NATIONALPRACTITIONER DATABANKQUESTIONNAIRE -- PAGE2
--

d When wehave received adverse information from the Yes:l d 

Data Bank, ithasnot beenusefil. 

e We rarely receive adverse information in response to yes:s e 

a request. 

f The Data Bank responses are not used in our yes: 0 f 

credentialing process at all. 

g Other (EXPLAIN: ~ ‘es: 0 g 

8 Was the hospital board’s initial decision a temporary Yes: 8 8 

one pending fi.uther information? No: 192 

Missing: 57 

9 (Sk@ if YOUanswered NO to 7) 

On what date did the hospital make its final decision 

regarding Practitioner A’s privileges? (Write 

wide range of dates 

no final decisions 

were pending 

9 

“PENDING” if board’s jinal decision has not yet been 

made, then answer 10 through 15 with respect to the 

board’s initial decision.) 

10 Were privileges granted to Practitioner A as requested ~oS:~~ 10 

by Practitioner A? 

Missing or N/A: 44 

11 (Skip if you answered XES to 10) 

Were Practitioner A’s privileges denied (for initial 

Yes: 5 

No: 6 

11 

application) or revoked (for renewal application)? Missing or NJ’A:246 

12	 (Skip if you answered YES to 10 or 11) Yes: 3 12 

Were Practitioner A’s privileges restricted or amended ‘0:3 

in any way? Missing or N/A: 251 

13	 (Skip if you answered YES to 10 or 11 or NO to 12) 13 

In what way were Practitioner A’s privileges restricted or amended? 

a All privileges suspended (IF YES, FOR HOW yes: O a 

LONG?~ 

b May not perform certain procedures Yes:O b 

c May perform certain procedures only with another yes: I c 

practitioner 

d May co-admit patients only Yes:O d 

e Mandatory consultation for certain conditions yes: 0 e 

f Mandatory review before patient admission or Yes:O f 

discharge 

g Proctor assigned to review Practitioner A’s work yes: O g 

NATIONAL PRACTITIONER DATA BANK QUESTIONiVAIM PAGE 3 
--

Yes:2 h 

h 

14 

15 

a 

b 

16 

Other (IF YES, SPECIFY: 

) 

(Skip if you answered YES to 10 or 11 or NO to 12) 

Were these restrictions on Practitioner A’s privileges 

in place prior to the application? 

(Skip if you answered YES to 10 or 11 or NO to 12) 

Which of the following best describes the restrictions 

applied to Practitioner A’s privileges? 

Yes: 2 14


No:2


Missingor N/A: 253


(Check one) 15 

Routine (e.g., procedure(s) not approved at this 

hospital, restriction applied to all new hires, etc.) 

Specific to Practitioner A (e.g., applied because of 

particular event(s) in Practitioner A’s histo~) 

Were any other actions taken with regard to 

Practitioner A’s employment, privileges, or 

credentials (e.g., education requirements, drug testing, 

etc.)? 

(IF YES, EXPLAIN: 

) 

o a 

2 b 

Yes: 13 16 

No: 224


Missing or N/A: 20


NATIONZ4L PRACT~IONER DATA BANK QUESTIONNA~ PAGE 4 
--

AVAILABILITY AND ACCURACY OF INFORMATION 

117 Were you aware, from sources other tian tie Data Yes:175 17 

No: 72 Bank, of theadverse action or malpractice payment Missing or N/A: 10 

mentioned on the last page of this form? 

18	 (Sk@ if you answered NO to 17) 18 

From which of the following sources were you aware of the adverse 

action or 

a 

b 

c 

d 

e 

f 

g 

h 

i 

malpractice payment? 

Practitioner A (self-report) 

Licensing board in your state 

Licensing board in another state 

Malpractice insurer in your state 

Malpractice insurer in another state 

Other hospital in your state 

Hospital in another state 

Professional society in your state 

Professional society in another state 

~os:~~ a 

.“ 

N/A: 72 

Missing: 3 

yes:17 b 

No:154 

N/A: 72 

Missing: 4 

yes:3 c 

No: 168 

N/A: 72 

Missing: 4 

yes:35 d 

No: 136 

N/A: 72 

Missing: 4 

yes:4 e 

No: 167 

N/A: 72 

Missing: 4 

yes:13 f 

No: 158 

N/A: 72 

Missing: 4 

yes:5 g 

No:166 

N/A: 72 

Missing: 4 

Yes:z h 

No: 169 

N/A: 72 

Missing: 4 

yes:Z i 

No: 170 

N/A: 72 

Missing: 4 

NATION~ PRACTITIONER DATA BANK QUESTIONNAIRE PAGE 5 
--

j 

j Other source in your state Yes.’16 

(IF YES, SPECIFY: ~A1~ 

) 

k Other source in another state 

Missing: 5 1 

k 

yes:3 

~A~; 

M&g: 7 

Yes: 24 19


No: 142


Missing or N/A: 91


Yes: 48 20


No: 197


Missing or N/A: 12


Yes: 40 21


No: O 

Missing or N/A: 217 

(IF YES, SpECIFy: 

) 

(Skip if you answered NO to 17) 

Was the information you received in the Data Bark 

response inconsistent in any way with the information 

reported by any of the above sources? 

(IF YES, WHICH SOURCES? 

) 

Did you make additional inquiries (for example, to a 

malpractice insurer or another hospital) to confirm the 

accuracy of the Data Bank response or to obtain more 

detailed information on its content? 

(Skip if you anwered NO to 20) 

Did your additional inquiries show the Data Bark 

response to be accurate? 

(IF NO, EXPLAIN: 

\ 

J 

19 

20 

21 

NOTE: Questions22-25 refer to the entire Data Bank response, not just to the report attachedto this 

questionnaire. Therefore, if you receivedmore than one report from the Data Bank on Practitioner A, 

please considerthem all in answeringQuestions22-25. 

22 

23 

a 

b 

1


Yes:20 

Were you aware of any disciplinary actions, or No: 228 

malpractice payments involving Practitioner A that Missing or N/A: 9 

were — not contained in the response from the Dati

Bank? 

(Skip if you anwered NO to 22) 

How many disciplinary actions and malpractice payments were you aware 

of that were ~t contained in the response from the Data Bati? 

Number of disciplinary actions I rew. aware of I 

2 aware of 3 

1 aware of 4 

Number of malpractice PaYments ~~~~rea~fl ‘f 1 

1 aware of 3 

1 aware of 7 

1 aware of 11 

22 

23 

a 

b 

NATIONAL PRACTITIONER DATA BANK QUESTIONNAIW PAGE 6 
--

24	 (Skip if you answered NO to 22) 24 

How many of these disciplinary actions and malpractice payments 

occurred @ September 1, 1990? 

a Number of disciplinary actions ~ w. aWWeof ~ a 

1 aware of 2 

b Number of malpractice payments d w“ awareOf~ b 

4 aware of 2 

1 aware of 5 

25	 (Skip if you answered NO to 22) 25 

Which of the following sources provided information about disciplinary 

actions or malpractice payments that were n- contained in the response 

from the Data Bank? 

a Practitioner A (self-report) 

b Licensing board in your state 

c Licensing board in another state 

d Malpractice insurer in your state 

e Malpractice insurer in another state 

f Other hospital in your state 

g Hospital in another state 

h Professional society in your state 

i Professional society in another state 

j Other source in your state 

(IF YES, SPECIFY: 

) 

k Other source in another state 

(IF YES, SPECIFY: 

) 

NATIONAL PRACTITIONER DATA BANK QUESTIONNAIRE 

y“S’18 a 

yes:~ b 

y~~:~ c 

yes:3 d 

yes:~ e 

Yes:5 f 

Ye’:~ g 

Yes:~ h 

yes:~ i 

Yes:3 j 

Ye’:~ k 

PAGE 7 
--

CONSIDERATION OF INFORMATION 

26	 Based on the notes in Practitioner A’s file and your personal knowledge 26 

of Practitioner A’s application, which of the following people or groups 

had access to and used the response from the Data Bank in making a 

decision regarding Practitione~ A’s application? 

a Department chair Yes: 183 a 

NO: 60 

Missing or N/A: 14 

b Chief of medical staff Yes: 148 b 

No: 95 

Missing or N/A: 14 

c Hospital administration (CEO, Vice President, etc.) Yes: 139 c 

No: 104 

Missing or N/A: 14 

d Credentials committee Yes: 192 c1 

No: 48 

Missing or N/A: 17 

e Medical staff executive committee Yes: 164 e 

No: 78 

Missing or N/A: 15 

f Hospital board subcommittee Yes: 71 f 

No: 162 

Missing or N/A: 24 

g Full hospital board Yes: 138 ~ 

No: 104 

Missing or N/A: 15 

NATIONAL PRACTITIONER DATA BANK QUESTIONNAIRE PAGE 8 
--

UTILITY OF INFORMATION


27 Including the report on the last page, how many Data Range from 1 to 27 

Bank reports on Practitioner A did YOUreceive in to~l ~~~~s~ =$ 

a 

b 

c


d 

e


f 

g 

h 

from this request? 

(Skip if you answered “1”to 27) 

Overall, was the information contained in the 

complete Data Bank response (i. e., all reports 

combined) useful to you? 

IF YES, WHY? 

Information was unavailable elsewhere 

Information confirmed other reports that were 

available elsewhere 

Information helped us to judge practitioner’s 

competency 

Information helped us to judge practitioner’s Yes: 15 

professionalism 

Other (EXPLAIN: ) Yes: 2 

IF NO, WHY NOT? (Check all that apply) 

Information was available elsewhere Yes: 13 f 

Information was inaccurate Yes: 1 g 

Information did not help us to judge practitioner’s Yes: 8 h 

competency or professionalism 

missin’g or NA, 89


had multiple reports.


Ave: 2.98 repo?ts


Yes: 71 28


No: 12


Missing or N/A: 174


(Check all that apply) 

Yes: 21 a 

Yes: 49 b 

Yes: 25 

d 

e 

i Information was not provided in a timely manner 

i Other (EXPLAIN: ) 

(Skip if you answered “1”to 27) 

Would your decision regarding Practitioner A have 

been different if you had D@received the reports from 

the Data Bank? 

IF YES, HOW (then skip to 31)? 

a Would have granted requested privileges 

b Would not have granted requested privileges 

c Would have restricted privileges 

d Would not have restricted privileges 

Yes: 2 i 

Yes: 4 j 

Yes: 2 29 

No: 84 

Missing or N/A: 171 

(Check one) 

Yes: O a 

Yes: 1 b 

Yes: 1 c 

Yes: O d 

NATIONAL PRACTITIONER DATA BANK QUES7TONNAW PAGE 9 

28 

c 

29 
--

e


> Other (EXPLAIN: ~ “s: 0 

IF NO, WHY NOT? 

fl 

f Would have restricted or denied privileges anyway ““:2 

g 

g Already knew, from other sources, about information 

reported in Data Bank responses 

yes:51 

(Check all that aPPIY) 

h 

h Data Bank responses did not indicate a problem that yes:42 

warranted restricting or denying privileges i 

i Did not receive Data Bank responses in time	 to affect ‘es: 3 decision 

J 

j Other (EXPLAIN: ~ “s’2 

30 

(Skip if you answered “YES”to 29) 

Did the reports you received make you feel more


cotildent, less confident, or no different about the (Check one)


decision you made regarding Practitioner A?


Missing 180 

25 

a More confident 

1 

LZSS cotildent 2 

b 

NO different 48 ( 

c 

yes: 203 31 

Overall, was the information contained in the Data No: 40 

Bank report on the last page useful to you? yes and No: 1 

Missing or N/A: 13 

IF YES, WHY? (Check all tit aPPIY) 

~ 

a Information was unavailable elsewhere Yes:51 

1 

b Information confirmed other reports that were Y’S:132 

available elsewhere 

c Information helped us to judge practitioner’s Y’S:64 

competency 

d Information helped us to judge practitioner’s yes:50 professionalism 

e Other (EXPLMN: ~ ‘es: 12 

(Check all that RPPIY)

IF NO, WHY NOT? 

f 

f Information was available elsewhere yes:30 

g 

c woulm’’z?iz$~~a j!i%fkri~ ~ ~ 

d 

d Would not have restricted privileges Y’S:O 

NATION& PRACT~IONER DATA BANK QUESflONNA~ PAGE 9 
--

h 

h Information did not help us to judge practitioner’s 

competency or professionalism 

i Information was not provided in a timely manner 

j Other (EXPLAIN: ) 

Would your decision regarding Practitioner A’s 

privileges have been different if you had n~ received 

the report on the last page from the Data Bank? IF YES, HOW? 

yes:18 

1
 Yes: 7 II


yes: 6 j 

Yes: 5 32


No: 227


Missing or N/A: 25


a 

b 

c 

a 

b 

d 

e 

Yes: 2 

Would have granted requested privileges 

Yes: 2 

Would not have granted requested privileges 

Yes: 1 Would have restricted privileges 

Yes: O 

Would not have restricted privileges 

Other (EXPLMN: ) 

IF NO, WHY NOT? 

Would have restricted or denied privileges anyway 

Already knew, from other sources, about information 

reported in Data Bank response 

Data Bank response did not indicate a problem that 

warranted restricting or denying privileges 

d 

Yes:2 d 

(Check all that WPIY) 

Yes: 7 I 

Yes: 122 f 

Yes: 125 1 

i Did not receive Data Bank response in time	 to affect yes:17 decision 

) Yes: 10 

j Other (EXPLAIN: 33 

3 (Skip if you answered “=S” to 32) 

Did the reports you received make you feel more 

confident, less confident, or no different about the (Check one) 

decision You made regarding Practitioner A? 

Missing 67 

49 a 

a More confident 

uss confident 7 k 

b 

NO different 132 c 

J c 

NATIONZ4L PRACT~ONER DATA BANK QUESTIONNAIRE PAGE 11 

c 
--

NOTE: The remaining questions do not concern the specific case of Practitioner 

A, but rather your general experience with and attitudes about the Data Bank. 

GENERAL QUESTIONS ON THE


NATIONAL PRACTITIONER DATA BANK


34	 How, if at all, have the other parts of your credentialing procedures been 34 

affected by the availability of the Data Bank? 

25 respondents discussed how the process is more costly or has been delayed by the Data 

Bank, 24 discussed how hiring or granting of privileges now is dependent upon first 

receiving the Data Bank response, 22 discussed how the Data Bank que?y is required for 

all applicants, and 22 discussed how the Data Bank is used to verify information on 

practitioner’s applicah”on. A host of other changes were mentioned by other respondents. 

35	 Please rate the following four types of information maintained in the Data 35 

Bank in terms of their usefulness to you--in practice or in theory--in the 

practitioner credentialing process. (Let 1 = extremely useful and 

4 = not at all useful.) 

a Hospital disciplinary actions/privilege restrictions ~TING: a 

Mean: 1.53 

S. D.: 0.89 

b Licensing board actions ~TzNG: b 

Mean: 1.53 

S. D.: 0.92 

c Malpractice payments ~TING: c 

Mean: 2.00 

S.D.: 0.99 

d Professional society disciplinary actions ~TzNG: d 

Mean: 2.25 

S. D.: 1.18 

36 How useful to you are responses from the Data Bank (Check one) 36 

that do not list any adverse information? 

Missing 6 

a Extremely useful 28 a 

b Very useful 37 b 

c Moderately useful 67 c 

d Somewhat useful 60 d 

e Not useful 58 e 

Please explain: 22 explained that it confirms information provided by other sources 

ijositive); 7 felt the Data Bank was incomplete or had insuf~cient informatt”on. 

NATIONAL PRACTITIONER DATA BANK QUESTIONNAIRE PAGE 12 
--

37 All things considered, do you feel it is worthwhile to Yes: 170 37 

No: 69 

query the Data Bank about all practitioners in your Missing: 18 

hospital as current law requires? 

Please explain: 25felt it was usejid because it provided useful documentti”on for 

credentialing or priw”leg”ng; 18 felt it was not worth the tz”meor money. 

38	 What kind of information ~ currently maintained by the Data Bank 38 

would be useful to you? 

39	 Please list any additional comments and suggestions you have about the 39 

operation of the National Practitioner Data Bank. 

This is the end of the survey. Thank you for taking the time to complete it. Please return 

your completed survey in the business-reply envelope to: 

Office of Evaluation and Inspections


Office of Inspector General


U.S. Department of Health and Human Services


Room 2475, J.F.K. Federal Building


Boston, MA 02203


If yOUhave questions, please call David Veroff or Barry McCoy at 617-565-1050. 

NATIONAL PRACT~ONER DATA BANK QUESTIONNAIRE PAGE 13 
APPENDIX C 

COMPLETE COMMENTS ON THE DRAFT REPORT 

c-1 
‘S-U*, ~ 

/“4<+ 

.

.“ DEPARTMENT OF HEALTH & IIIJhlW SERVICES Public He.akh Suvica 

3

9

‘%,

%,,, Memorandum 

FEB2fm 

OfIte 

hom Assistant Secretary for Health 

subject
 Office of Inspector General (OIG) Draft RepOxtS on the 

usefulness and Impact of National Practitioner Data Bank 

Reports to Iiosp~talS and Managed Care Organizations, 

To OEI-01-94-00030 and OEI-01-94-00032 

Inspector General, OS 

Attached are the Public Health Servi-ce comments on the subject 

OIG draft reports. We appreciate the efforts of OIG 6taff in 

developing these reports. We offer only a few general 

comments and a sugges~ed editorial change. 

(j#/$ 42 L 

Philip . Lee, M.D. 

Attachment 
~

PBLH T S RVICE P OFFICE OF XNSPECTOR 

GENEM (OIG) DRAFT REPORTS ON THE USEFULNESS AND IMPACT OF THE 

NATT ONAL PRACTITIONER DATA BANK TO HOSP TALS AND MAXAGED CAR 

~R 

DECE MBER 1994


The OIG inspections were performed at the request of the Health 

Resources and Services Administration (HRSA). The HRSA asked OIG 

to update the February 1993 inspection report on the usefulness 

and impact of National Practitioner Data Bank reports to	

hospitals, and to consider the Data Bank’s relevance to managed


care organizations.	

we appreciate the efforts of the OIG staff and their cooperation	

with program officials in HRSA in developing these reports.	

‘These reports reflect many of the changes that we suggested to	

OIG staff during the exit conference and on subsequent occasions.


we believe that these xeports will be helpful in administering	

the program.	

Nevertheless, we believe that a wording change is needed to	

pxovide greater clarity in the “Background” section of the	

Executive Summary of both reports. The first paragxaph in these	

sections states thaC “[Hospitals are required to request	

information from the flata Eank about every physician and dentist	

who applles for appointment (they must qu=yat least every two	

years). ” The requirement might be better understood by readers	

if the parenthetical phrase was deleted and replaced with the	

following sentence: “In adciition, hospitals nmst.query at least	

once every two years on every practitioner who ~S on ~hei=	

medical staff or who has privileges. “	
--

/“’-% 

i 

s 

s 

s

%(L 

�t-4 

To: 

From: 

Subject: 

OEPARTMENTOF HEALTH& HUMAN SERVICES -ice d theSecrelaw 

Weshinglon, O.C. 20201 

FEB 27 W5

JuneGibbs Brown 

Inspector General 

Assistant Seeretary for 

Planning and Evaluation 

OIG Draft Reports on the Usefulness and Impact of the National Practitioner 

Data Bank 

I have reviewed two draft inspection reports entitled, “National Practitioner Data Bank 

Reports to Hospitals: Their Impact *d Usefulness” and “National Practitioner Data Bank 

Reports to Managed Care Organizations: Their Impact and Usefulness. ” The purpose of the 

sumeys, as indi-ted in the title+ is to determine if the users consider the data bank to be 

usefid in making decisions about granting privileges to physicians, The purpose of OIG’S 

inqui~ is commendable and the survey methodology seems appsupriate. 

1 think, however, that the conclusions dxawn by OIG are a matter of interpretation and that 

the findings of the report cadd be used to support conclusions other than those drawn by 

OIG. For example, the findings from the survey of managed care entitiessuggest that the 

data bank is, contrary to 010’s contention, duplicative as indicated by the following 

responses. 

Officials said they setdom or rarely relied on a report from the data b~k “indeciding 

to deny privileges. In fact, only 8% (questionnaire item 27, page 8) of the 

information was reported unavailable elsewhere. This implies that 92% found the 

information available elsewhere. 

The major finding that supports the OIG’Sconclusion of data bank usefulness is the 

answer to the question, “OvcralI, was the information contained in the complete Data 

Bank response (i.e., all reports combined) useful 10you’?”(questionnaire item 27, 

page 8). Of those who answered, 96% said yes; however, only 60 of 200 

respondents or 30!%of the sample answeml the question. One em~d interpret this 

finding to indimte that only 30% of the sample could answer positively. 

I recommend that OIG discuss why its conclusion that the data bank is useful is a better 

reading ofthe evidence than the conclusion reached ab~­ -%%%s= 

Prepar4 by; Mary Bymes 690-7388 
American Hospkal Association 

One North Franklin 

Chicago, IIlino!s tI0606 

Telephone 312.422.3000 

February 6, 1995	

.June Gibbs Brown	

Inspector General	

Office of Inspector General	

Department of Health & Human Services	

Washington, D.C. 20201	

Re:
 Draft Repoti - National Practitioner Data Bank Reports to Hospitals: Their Usefulness 

ond Impact 

Dear Ms. Brown 

The American Hospital Association (AHA), on behalf of its 5.000 hospital members. welcomes 

this opportunity to comment on the OffIce of Inspector General’s draft report on the usefulness 

and impact of National Practitioner Data Bank reports to hospitals. Because our members are 

principal users of Data Bank information and the chief financial support for Data Bank 

operations. the AHA is exttemely interested in knowing how hospitals use this information and 

whether it is useful to them during the credentialing and privileging process. 

According[othedraft, hospitals are finding Data Bank information both more useful and more 

timely than in a previous survey, conducted shortly ~f~r [he Dam Bank WaS imPlemen~d” 

Although these findings are encouraging, OIG also reports that the proportion of “ne w“ 

information the Data Bank supplies actually has declined. While there may be some value in the 

supplemental r(~le the Data Bank seems to have assumed in credentialing and privileging, we 

question whether that role comes at too high a price. In other words, is the confirmatory 

informs tion ~vorth the significant administrative and financial burdens the Data Bank imposes on 

hospita!s und other Data Bank users? 

In short. although we are pleased that a greater percentage of hospitals fmd the Data Bank 

generd[ly usetiJ. we are concerned that Data Bank information. acquired pursuant to statutory 

mandute md at high cost to users, is not proving appropriate to and effective in hospital 

decisionmaking. 

Sinwrcl\. / ,,$: 
herican Medical Msociation 

PfivwcmtmdediCJlt@(IIlhPMMh II( Arnerir;t 

ham S. Tedd,MD 516NorthStareStrwt 

Esemtive Vice FresldQnt Chkago, Illinois 60610 

February 1, 1995 

The Honorable June Gibbs Bruwn 

Inspector General


Office of Inspector General	

3[2464-5000 

312464-4184Fax 

Department of Health and Human Services	

330 hxiependenec Avenue, SW - Room 5246	

Cohen Building	

Washingmn, D.C. 20201	

f)raft Inspection Repon. ~m’oml Praaitioner Dara Bank Reporrs to Hospirals: 

2-

The /&erican Medicai Association (AMA) is pleased to respond to your request for 

comments on the OffIce of Inspwor ~ne=l’s (010 draft inspection report, National 

Practitioner Data Bati Repofls ~0 Hos@ak Iheir Usefdness and Impacr, Decernkr 

1994. l%c SQ~d PWPOSCOf this s~dy was (O update an assessmentof tic usefulness and 

impact of information in M Natiod Pmctit~onerData Bank (NPDB) to hospitals. 

After reviewing the December draft report, the AMA concludes that the report only 

partially addresses the useflhess and impact of the NPDB aud doea not agtec with the 

concluding observations. The AMA is very disappointed to see she serious flaws wc 

identified
 inthe February, 1993 OIG rcpon repea@d in this report. The AMA offers the 

following commentson thedraftreport.


The draft report again fafls to di=lo= the toti universe of queries or any operational 

information. Since he AMA citi this m.arm as a most serious deficiency in the 

Fcb~~, 1993 rtport, the MA qucs~o~ WhY@ OIG is not P=cn@! a m~m 

comprehensive and accurate assessment of h usdikss and impactof the NPDB. TM 

AMA believes that some of the critical information from the August, 1994 OIG report, 

Natioml Pnrctizimer Data Bmk: Profile of h.ialchesUp&ate,must be id.tiiedin this 

currentreport, For example, the foIlowing information needs to be included in the 

background section of the drafi report 

As of April, 1994, the Data Bank had received 3,462,297 requests for information 

and 82,623 reports of adverse actions or malpractice pqmwnts. As 8 rtsd Of M 

queries made by April of 1994, 152,941 matches had occurred (144,649 matches 

as of February of 1994). 
Page 2	

February 1.1995	

The Honorable June Gibbs Brown	

‘IMSinformation provides a match me of 4.4 percent. Ninety-six percent of the queries 

resulted in no adverse action or malpractice information. The background section of the 

draft report presents a wry different pictw=. The draft report states, “as of February 25, 

1994, hospi~s had received. in response to queries. 108.552 reports of malpractice 

payments Or adverse aCtiOIKSagainst physicians. dentists, and other health care 

practitioners. ” This statement is wrong. The AMA believes that the word “matched” 

must be inserted between “108,552” and “reports” to rein.forcethe fact that this report is 

only looking at approximately 4.4 percent of the universe of queries. 

The report would be swengthened if the 010 would anaiyze tie matched reports baaed on 

the reason the hospitid was querying the NPDB. Of those rcspondema who queried the 

data bank, 69 pcmem did so co meet their statutorily mandated two year rquirememsf 29 

Pement didso on initial privileging or employment applications. and 2 pereent did so for 

professional review purposes. That analysis demonstrates that matches for initial 

applicants may be more imPor@ntthan if a practitioner was being tmerkmtialed. In the 

Februay. 1993 OIG repofi. 42 percem queried on initial privileging or ernpioymcm. 

This change in the reason for the query could be why the utdmovvninfomnation decreased 

from 40 pemcnt to 28 petcent. 

The draft repro stares that 83 percentof hospi~ officials in period B now consider the 

matched reports useful compared to 58 percent in period A. Again, however, the major 

reason was that the information only cofilrmed other reports that were available 

elsewhere. The draft report atr.emptsto justify the low match rate and impact on 

crcdent.iaiing by stating that 77 pement of the respondents found thatno adverse 

informationwas at least somewhat usefid and 71 pereetn found it worthwhile to query as 

rhe current law requires. These resuks may have km predictable because the Likert 

scale was skewed in favor of providing a positive response, and the other question was to 

elicit a simple yes or no response. Forty-two petunt of the respondents who explained 

their response stated that tie NPDB wss not WOrththe tune or money. 

The AMA was pleased to see that the NPDB response time had impruved significantly. 

However. the AMA is very conccmed about growing evidence that the NPDB is not 

rcporcingall the information it should to hospiuds. Almost S pement of the hospiuds 

idicated that the match report was incomplete. This indicates that there arc serious 

problems whh the matching algorithm or how the reports are being entered into the 

NpDB files. Since many hospitals justifi the usefulness on conftrmatiott of information, 

[his growing trd raises questions about the “reai” Usefidness. The AMA bdieves r-hat 

this is a significant f~ing and should be included in tie executive summary portion of 

thc RPOR. In addi~ion. tie ~biic Heajt~ sc~lce n=ds (O ~C im.m~~te SWPStO 

identifi rhe problem and correct it. 
Page 3	

Fcbxuary 1.1995	

The Honorable June Gibbs Brown	

The most impo~nt indi~tor of usefulness is whe~er ~ ma~h~ repons had an impact	

on crcdemialing decisions. AlthoughperiodB shows a slight improvement over period	

A, only 2 percent of ~C ma~h~ rCPOHSmade a diffemflcc in a privileging decision 

compared to 1 percent in period A. Whh a match rate of 4.4 percent and only 2 percent 

of matchedrepom hv~g m impct on privileging. M ovcd hpact is 0.09 percentor 

about one out of every 1.100 queries. After review of the draft report. the MUA 

seriously questions thc OIG’S concluding observations. The growing trend of tiw NPDB 

failing to provide complete information on a practitioner with an adverse action report 

and/or a ma]prac~icepayment rcpott rakes serious conoetns ah NPDB reliability as a 

centralized source of Mo-tion. In addition. tie Dam Bank is not a cost-effective 

mechanism to protect the public by preventing incompetent -or unprofessional 

practitioners from practicing in hospitals. Very rarely did an NPDB query affect 

privileging decisions of hospnrds. Only 0.09 percent of the queries affect a credentiaiing 

decision. 

here is also no data presented to suggest that hospitils are overly reluctant to take 

adverse actions against incompetent and/or unprofessional practitioners. ln fact. hospitals 

and their medical staffs MC t.ddng SWPStO enh=c their continuous quaiity improvement 

programs to improve their patient care. 

It is difllcult to justify tie dtit ati indirect costs of operating the NPDB to provide 

reports that did not chmge nything or provided information hat simpiy confirmed 

information thatwas already known. We urge you to consider our comments in order to 

adequately assess the utility and impact of the NPDB to hospitals. 

krnes S. Todd, MD 
1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

APPENDIX D 

NOTES 

Department of Health and Human Services, Officeof Inspector General, Mzti7mal 

Practitioner Data Bank: Profile of Matches Update, 0EI-01-94-OO031, 

August 1994. 

Department of Health and Human Services, Office of Inspector General, 

National Practitioner Databank: Useji.dness and Impact ofReports to Hospitals, 

0EI-01-90-O0520, February 1993. 

Thirty-eight percent rated professional society action reports extremely usefhl. 

Department of Health and Human Services, Public Health Service, Health 

Resources and Services Administration, Bureau of Healti Professions, Division of 

Quality Assurance, National Practitioner Data Bank: Third Annual Report 

(September, 1992 -August 31, 1993),1993,7. 

Of the 17 percent of reports found not useful, this is the primary reason they were 

found not useful. 

Over 23 percent did not answer why the reports did not have any impact on their 

decisions. 

We are 95 percent confident that the proportions of reports that provided new 

information to hospitals is between 20,033 and 30,048. 

We are 95 percent confident that the proportion of reports that affect hospital 

credentialing decisions is between 45 and 2,995. 

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