Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

NATIONAL PRACTITIONER DATA BANK:


USEFULNESS AND IMPACT OF REPORTS


TO STATE LICENSING BOARDS


MARCH 1993

OFFICE OF INSPE~OR GENERAL 

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

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

programs as well as the health and weifare of beneficiaries sewed by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and 

inspections conducted by three OIG operating components: the Office Of Audit Semites, the 

Office of Investigations, and the Office of Evaluation and Inspections. The OIG also informs 

the Secretary of HHS of program and management problems and recommends courses to 

correct them. , 

OFFICE OF AUDIT SERVICES 

The OIG’S Office of Audit Sewices (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in 

carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIG’S Office of Investigations (01) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 

unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions, 

administrative sanctions, or civil money penaities. The 01 also oversees State Medicaid fraud 

control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 

OFFICE OF EVALUATION AND INSPECTIONS 

The OIG’S Office of Evaluation and Inspections (OEI) conducts short-term management and 

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

the Congress, and the public. The findings and recommendations contained in these inspection 

reports generate rapid, accurate, and up-to-date information on the efficiency, vulnerability, 

and effectiveness of departmental programs. 

This report was prepared under the direction of Mark R. Yessian, Ph. D., the Regional 

Inspector General, and Martha B. Kvaal, Deputy Regional Inspector General, Boston Region, 

Office of Evaluation and Inspections. Participating in this project were the following people: 

Boston Region Headquarters 

David Veroff, R@ect Leader Alan Levine 

David Schrag, Lead Analyst 

For additional copies of this repo~ please contact the Boston Regional Office at 

(617) S6S-105O. 
Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENEML 

NATIONAL PRACTITIONER DATA BANK:


USEFULNESS AND IMPACT OF REPORTS


TO STATE LICENSING BOARDS


MARCH 1993 OEI-01-90-00523


--

EXECUTIVE SUMMARY 

PURPOSE 

The purpose of this study is to assess the utility of National Practitioner Data Bank 

reports to State licensing boards. 

BACKGROUND 

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

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

other health care entities, State licensing boards, and professional societies against 

licensed health care practitioners. It provides hospitals, licensing boards and other 

health care entities with information relating to the professional competence and 

conduct of physicians, dentists, and other health care practitioners. It is operated by a 

contractor to the Health Resources and Services Administration (HRSA) of the Public 

Health Service (PHS). 

The primary users of the Data Bank are hospitals, which are required by law to query 

the Data Bank about practitioners at the time they apply for hospital privileges and at 

least every two years thereafter. State licensing boards are permitted to query the 

Data Bank, but are under no mandate to do so. Few licensing boards have opted to 

query. 

Licensing boards receive much of the information contained in the Data Bank even 

without querying. They automatically receive copies of reports to the Data Bank from 

malpractice insurers regarding payments (judgments or settlements) made within their 

own States. They also act as conduits to the Data Bank for hospitals and professional 

societies in their States, receiving reports of adverse actions from these sources and 

forwarding copies to the Data Bank. In addition, many States have their own laws 

mandating reports to boards of malpractice payments and hospital discipline. Medical 

and dental boards, furthermore, routinely get information on adverse actions against 

physicians and dentists taken by their counterparts in other States through 

clearinghouses run by those boards’ national organizations. Therefore, information 

contained in the Data Bank that is not routinely available to State boards consists 

primarily of malpractice payments and hospital disciplinary actions occurring in other 

States. 

In our inspection, we sought to provide an early assessment of the usefulness and 

impact of information in the Data Bank to hospitals and State licensing boards. 

Toward that end, we based our data selection and analysis on matches that is, the 

occasions on which the Data Bank provided records of malpractice payments or 

adverse actions to querying entities. A separate report on hospitals’ experiences was 

based on a sample of 200 of the 19,122 matches sent to hospitals from the Data Bank 

in the period from its opening until March 19, 1992 (see “National Practitioner Data 

i 
Bank: Usefulness and Impact of Reports to Hospitals,” OEI-01-90-00520, February 

1993). In that same time period, boards only had 68 matches. Because the number of 

matches was small, the report on boards’ experiences assesses the entire universe. 

From the opening of the Data Bank in September 1990 through March 19, 1992, 13 

different boards submitted 59 queries that matched one or more reports about 

practitioners in the Data Bank. We sent 1 questionnaire regarding each query to 

these boards, and received 44 replies from 9 boards. 

FINDINGS 

USEFULNESS TO STAZ73LICENSING BO~Si 

usejid to Sttzte boardk 

Measured by both objective and subjective criteria, 

providing valuable information to State boards. 

Most Data Bank msponw were 

the Data Bank appears to be 

Six of the nine responding State boards query about all first-time applicants for 

licenses. 

Ten of the 44 Data Bank responses provided information previously unknown 

to State board staffs. All of these responses yielded information from sources 

outside the States in which the querying boards were located. 

The Data Bank has delivered accurate reports to State boards, and its 

timeliness has been improving. 

State board officials found 29 of 44 Data Bank responses useful. The most 

frequently cited reason for Data Bank reports’ usefulness was that they 

confirmed information about practitioners that State board officials already 

knew. 

Neither the source of reports nor, for malpractice reports, the payment amount 

affected the proportion of Data Bank responses that State board officials rated 

useful. 

IMPACT ON DECISIONS: Data Bank repo~ never led State boardk to make licensure 

or dimipliharydeczkions they wozdii not have made without the reports, even when the 

reprts provided ihformatz”onthat State boarak did not already know. 

By the time of our survey, responding boards had reached decisions on the 

applications or investigations of 20 of the 44 practitioners involved in matches. We 

evaluated the reports’ impact on those decisions by asking State boards the following 

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

had not queried the Data Bank? 

ii 
None of the 20 decisions would have been different, according to State board 

officials, if the boards had not queried the Data Bank. 

Fifteen of the 20 Data Bank responses regarding practitioners about whom 

final decisions were made had little chance to have an impact on those 

decisions. Each of these responses either arrived after the decision was made 

or duplicated available information. 

Five Data Bank responses arrived before State boards’ decisions were finalized 

and contained information that neither the practitioner involved nor any other 

sources had provided, but did not have an impact on State boards’ decisions. 

In four of these cases, the State boards granted full approval to the 

practitioners’ requests for licenses. In one case, a board denied a license for 

reasons unrelated to its receipt of information from the Data Bank. 

CONCLUSION 

Most licensing boards have not queried the Data Bank. Among their reasons for not 

querying is that they already receive much of the information sent to the Data Bank. 

Our results suggest, however, that boards may be underestimating the value of 

querying the Data Bank. Two-thirds of the responses that nine boards have received 

in response to queries have been considered useful, and several responses have 

provided information that the boards did not already have. 

Boards might make the best use of the Data Bank by querying in cases where 

information from out of State is needed, because boards are less likely to obtain 

information routinely from out-of-State sources than in-State sources. Boards could 

design targeting strategies with this in mind. For example, they could query about all 

practitioners who apply for licenses after practicing in other States. Or they could 

query about current licensees who also maintain licenses in other States. 

COMMENTS ON THE DRAFT REPORT 

We received comments on our draft report from the Public Health Semite (PHS) and 

the Assistant Secreta~ for Management and Budget (ASMB) within the Department 

of Health and Human Services and from the Federation of State Medical Boards 

(FSMB) and the American Association of Dental Examiners (AADE). In appendix C, 

we reproduce each set of comments in full and provide our responses to them. 

A common comment was that the findings were difficult to analyze because the 

sample size was small. We note that the report was not based on a sample, but was 

based on the universe of matches at the time of the study. While we agree that the 

experience is limited, we feel our study provides meaningful insight into the Data 

Bank’s utility. 

... 

111 

TABLE OF CONTENTS 

PAGE 

EXECUTIVE SUMMARY 

mODU~ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

mugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...=... 

. Usefulness to State Licensing Boards . . . . . . . . . . . . . . . . . 

�Impact indecisions . . . . . . . . . . . . . ...=. . . . . . . . . . . . . 

CON~USION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

COMMENTS ON THE D~REPORT . . . . . . . . . . . . . . . 

APPENDICES 

A 

B: 

c: 

D: 

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...=.. 

. . . . . . . ..*.. � �� 

� � � � � � � � � � � � � � � 

� � � � � � � � � � � � � � � 

� � � � � � � � � � � � � � � 

� � � � � � � ����� � �� 

1 

3 

3 

6 

9 

� � � � � � � � � � � � � 

� � � � � � � ����� � 

Summary of Licensing Boards’ Responses to OIGMail Sumey . . . . . . . . . . . 

. 10 

A-1 

B-1 

Detailed Comments on the Draft Report and OIG Response to the Comments C-1 

Notes . . . . . . . . . . . . . . . . . . . . . . . . . .............”””~””””””-” ““”D-l 

--

INTRODUCTION 

PURPOSE 

The purpose of this study is to assess the utility of National Practitioner Data Bank 

reports to State licensing boards. 

BACKGROUND 

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

maintained records of malpractice payments and adverse actionsl taken by hospitals, 

other health care entities, State licensing boards, and professional societies against 

licensed health care practitioners. It provides hospitals, licensing boards and other 

health care entities with information relating to the professional competence and 

conduct of physicians, dentists, and other health care practitioners. The Data Bank 

was established by Title IV of the Health Care Quality Improvement Act of 1986 

(P.L. 99-660, as amended) and is funded by user fees and Federal outlays. It is 

operated by Paramax Systems Corporation (a subsidiary of Unisys Corporation) under 

contract to the Health Resources and Semites Administration (HRSA) of the Public 

Health Semite (PHS). 

The primary users of the Data Bank are hospitals, which are required by law to query 

the Data Bank about practitioners at the time they apply for hospital privileges and at 

least every two years thereafter. State licensing boards are permitted to query the 

Data Bank, but are under no mandate to do so. Few licensing boards have opted to 

query.2 

Licensing boards receive much of the information contained in the Data Bank even 

without querying. They automatically receive copies of reports to the Data Bank from 

malpractice insurers regarding payments (judgments or settlements) made within their 

own States. They act as conduits to the Data Bank for hospitals and professional 

societies in their States, receiving reports of adverse actions from these sources and 

forwarding copies to the Data Bank. In addition, many States have their own laws 

mandating reports to boards of malpractice payments and hospital discipline. Medical 

and dental boards, furthermore, routinely get information on adverse actions against 

physicians and dentists taken by their counterparts in other States through 

clearinghouses run by those boards’ national organizations. Therefore, information 

contained in the Data Bank that is not routinely available to State boards consists 

primarily of malpractice payments and hospital disciplinary actions occurring in other 

States. 

In our inspection, we sought to provide an early assessment of the usefulness and 

impact of-information in the Data Bank to hospitals and State licensing boards. 

Toward that end, we based our data selection and analysis on matches that is, the 

occasions on which the Data Bank provided records of malpractice payments or 

1 
adverse actions to querying entities. A separate report on hospitals’ experiences was 

based on a sample of 200 of the 19,122 matches sent to hospitals from the Data Bank 

in the period from its opening until March 19, 1992 (see “National Practitioner Data 

Bank: Usefulness and Impact of Reports to Hospitals,” 0EI-01-90-O0520, February 

1993). In that same time period, boards only had 68 matches. Because the number of 

matches was small, the report on boards’ experiences assesses the entire universe. 

This report examines why boards who have received reports elected to query the Data 

Bank, whether they found the information they obtained useful, and what impact the 

information had on board proceedings. Most of the boards involved were medical 

boards. 

METHODO~GY 

From the opening of the Data Bank in September 1990 through March 19, 1992, there 

were 59 queries from boards that matched a total of 68 reports about practitioners in 

the Data Bank. Thirteen different agencies submitted these queries: 11 medical 

boards, 1 dental board, and 1 umbrella agency representing several State boards. We 

sent 1 questionnaire per query to these boards and received 44 usable replies. 

Appendix A gives details of our methodology and provides information about the 

reports, practitioners, and State licensing boards included in this study. 

In this study, the term “report” refers to information about a single malpractice 

payment or adverse action that has been submitted to and stored by the Data Bank. 

The term “response” refers to information delivered to a licensing board in response to 

a query. A response may contain one or more reports about a practitioner named in 

a board’s query. Five of the 44 responses described in 

each, for a total of 49 reports. 

this study contained 2 reports 

We conducted our review in accordance with the Interim Standards for Inspections 

issued by the President’s Council on Integrity and Efficiency. 

OTHER REPORTS 

This report is one in a series of OIG studies on the Data Bank. Other studies include: 

National l?acti~ioner Data Bank: 

00530), August 1991 

National Practitioner Data Bank: 

90-00521), April 1992 

National Practitioner Data Bank: 

1992 

National l?actitioner Data Bank: 

(OEI-12-92-00290), August 1992 

National Practitioner Data Bank: 

Controls Over Authorized Agents (OEI-12-90-

Mai’practice Reporting Requirements (OEI-Ol -

Proj71eof Matches (OEI-01-90-O0522), April 

Ensuring Proper Access by Health Care Entities 

Usefulness and impact of Reports to Hospitals 

2 

(OEI-01-90-00520), February 1993 
FINDINGS 

USEFULNESS TO STAE13LICENSING BO~S: Most Data Bank reprts were UYejid 

to State boardh 

Whether a report from the Data Bank is useful to a licensing board depends on 

several factors. Some factors can be determined objectively, such as whether the 

report provides new information or duplicates other reports, whether it is accurate, 

and whether the report arrives at the board in time to be used during licensure or 

disciplinary proceedings. Other factors are purely subjective, such as whether the 

information is relevant to the reported practitioner’s competency and professionalism. 

Measured by both objective and subjective criteria, the Data Bank appears to be 

movidin~ valuable information to State boards. 1 v 

� Six of the nine 

licenses. 

responding State boards query about all first-time applicants for 

One measure of Data Bank reports’ usefulness is boards’ persistence in trying to 

obtain them. During the first 18 months of the Data Bank’s operations, the odds of 

receiving a report of a malpractice payment or adverse action in response to a query 

were slim. The 68 matches by State boards resulted from nearly 10,000 queries.3 

This is a match rate of less than 1 percent.4 

Despite these low odds, six State boards decided that the potential of receiving 

information as a result of a query justified the six dollar querying fee every time they 

received an application for an initial (as opposed to renewed) license. The six are 

medical boards in Alaska, Iowa, Kentucky, Louisiana, and Missouri, and an agency 

representing several boards in Florida. Some of these boards query under other 

circumstances as well. Louisiana and Florida query about all practitioners who apply 

for reactivation or reinstatement of their licenses, while Iowa and Florida query about 

certain practitioners who are under investigation. Alaska’s policies resulted in 

approximately 300 queries through the Spring of 1992; in Florida, the number of 

queries exceeded 5,000. 

The other boards responding to our survey query under more limited circumstances. 

The Washington medical board limits queries to certain practitioners under 

investigation. The Nevada medical board queries about a select group of license 

applicants. The Texas medical board has only queried the Data Bank once. 

Of the 44 queries in our sample, 37 were prompted by initial license applications, 3 by 

renewal applications, and 4 by investigations of current licensees. 

3 
� Ten of the 44 Data Bank responses provided information previously unknown 

to State board staffs. All of these responses yielded information from sources 

outside the States in which the querying boards were located. 

It creating the Data Bank, Congress was trying to meet the “national need to restrict 

the ability of incompetent physicians to move from State to State without disclosure or 

discovery of the physician’s previous damaging or incompetent performance.”5 One 

measure of the usefulness of Data Bank reports, therefore, is the extent to which they 

add to boards’ knowledge by providing information the boards do not obtain 

elsewhere. Another measure is the extent to which this information pertains to 

practitioners who move from State to State. So far, 10 reports to boards in response 

to queries have satisfied both criteria. Seven of these reports involved malpractice 

payments, two involved hospital privilege actions, and one involved a board licensure 

action. 

Boards do not always receive complete information from sources other than the Data 

Bank. Fifteen of the 44 practitioners involved in Data Bank reports received by 

boards did not inform the boards of the payments or adverse actions contained in the 

reports. Of the 12 Data Bank reports involving adverse actions taken by State boards, 

6 provided information that boards did not obtain from either the Federation of State 

Medical Boards (FSMB) data base or the originating boards themselves. Whether this 

communication gap results from reporting boards and FSMB failing to provide 

requested information or from querying boards failing to request information from 

these sources, we cannot say. 

� The Data Bank has delivered accurate reports to State boards, and its 

timeliness has been improving. 

During the planning and early implementation of the Data Bank, some observers 

feared that erroneous information about practitioners could be relayed from the Data 

Bank to Data Bank queriers.b But the Data Bank’s safeguards, such as allowing 

practitioners to dispute reports against them, seem effective in preventing the release 

of incorrect reports. Boards had almost no complaints about the reliability of 

information in Data Bank reports. No board in our sample responded that the Data 

Bank report it received was inaccurate. (Boards evaluated, or had a chance to 

evaluate, the accuracy of the information by comparing it to information they had 

already received or by making inquiries of other sources after they received the 

reports. Their judgments, therefore, are good indicators of the accuracy of the 

reports.) 

In most but not all cases, responses from the Data Bank contained complete histories 

of malpractice payments and adverse actions from September 1, 1990, through the 

dates of the responses. In 42 of the 44 cases, boards had no knowledge of any 

malpractice payments or adverse actions that should have been reported to the Data 

Bank but were not included in the response to the board’s query.’ We cannot judge, 

however, whether underreporting is a significant problem. Although it seems that the 

4 
Data Bank has full information on those practitioners who are reported, there remains 

the possibility that practitioners who should have been reported to the Data Bank 

never were. 

Timeliness is an important factor in the usefulness of the Data Bank, and the Data 

Bank seems to be improving in this area. For the 6 queries in our sample submitted 

in the Data Bank’s first 6 months of operation, the median response time was 97 

days.8 For the 19 queries submitted over the following 6 months, the median 

response time fell to 52 days. During the final 6 months of our study period, median 

response time to 11 queries was 41 days.9 (Respondents had not recorded dates of 

submission and/or response for eight queries in our survey.) 

. State board officials found 29 of 44 Data Bank responses useful. The most 

frequently cited reason for Data Bank responses’ usefulness was that they 

confirmed information about practitioners that State board officials already 

knew. 

Measured by board officials’ assessments, 66 percent (29 of 44) of Data Bank 

responses received between September 1, 1990, and March 19, 1992, were useful. Of 

the 29 responses they considered useful, board officials considered 19 useful at least in 

part because they confirmed other available information. The next most frequently 

cited reason was that they provided information unavailable elsewhere (eight 

responses). 

Not all board officials valued responses that confirm available information. Of the 

15 responses considered not useful, board officials considered 13 not useful at least in 

part because they were duplicative. 

. Neither the source of reports nor, for malpractice reports, the payment amount 

affected the proportion of Data Bank responses that State board officials rated 

useful. 

There were no significant differences in the percentage of responses judged useful 

according to the incident involved (payment vs. adverse action), amount of malpractice 

payment, location of report (in-State vs. out-of-State), or type of adverse action (table 

l).10 These results are contrary to expectations. Some observers familiar with the 

Data Bank and with licensing boards believe that reports of adverse actions would be 

more useful than reports of malpractice payments and that reports of large 

malpractice payments would be more useful than reports of small ones. 

lMPACT ON DECISIONS: Data Bank repo~ never led State boards to make licensure 

or dkipli?wy &chions they wouhi not have made wz”thoti the repo~, even when the 

reprts pmviibd informah”on that State boanik did not alreadj know. 

One can characterize the impact on State boards of information received in response 

to Data Bank queries in several ways. Impact can include giving board staff 

5 
just 

� 

lXB~ 1 

USEIWLN=S TO LICENS~G BOARDs oF D_RENT m= 

OF DATA BANK RESPONSES 

Number of Responses 

Type of respome (see endnote 10) responSes in considered 

useful suney 

Incident involved 

Malpractice payment 

Adverse action 

Amomt of malpra~= payment* 

Less than $50,000 

$50,000 or more 

Typ of adveme action 

Board licensure action 

Hospital privileges action 

Location of repofl 

Out-of-State 

In-State 

Note: None of these differences are significant 

The total of five malpractice 

26 18 (69%) 

18 11 (61%) 

7 5 (71%) 

14 10 (71%) 

13 9 (69%) 

5 2 (40%) 

41 27 (66%) 

3 2 (67%) 

at the 95 percent confidence level. 

amount payments was unavailable. 

SOURCE: OIG Survey of State Licensing Boards, Spring 1992 — 

confidence that they have complete information about their licensees. It can include files that could be used in the future should adding information to practitioners’ 

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

the outcome of decisions on practitioners who have applied for initial or renewed For this reason, we asked boards


licenses, or who may be facing disciplinary actions.


the folloting question: Would your decision regarding the practitioner have been


different if you had not queried the Data Bank?


. Because our measurement of impact focused on the boards’ decisions, we excluded 

any situations involving pending decisions from this analysis. By the time of our 

survey, responding boards had reached decisions on the applications or investigations 

of 20 of the 44 practitioners involved in matches. 

6 

I 
. None of the20decisions would have been different, according to Skateboard 

officials, if the boards had not queried the Data Bank. 

The 20 final decisions included 18 decisions on license applications and 2 decisions 

following investigations. The licensure decisions included 13 approvals, 3 rejections, 

1 restriction, and 1 probation. Boards closed both of the completed investigations 

without imposing sanctions. In no case did a board official say the outcome of the 

decision hinged on the response to a Data Bank query. 

� Fifteen of the 20 Data Bank responses regarding practitioners about whom 

final decisions were made had little chance to have an impact on those 

decisions. Each of these responses either arrived after the decision was made 

or duplicated available information. 

A variety of reasons explained why it was unlikely for Data Bank responses to have 

had an impact on licensure or disciplinary decisions. When boards received responses 

after their decisions had been made, the responses clearly could not affect those 

decisions. When boards were already aware from other sources of the information in 

the Data Bank responses, the responses themselves were unlikely to affect decisions. 

Board officials who received confirming information may have felt more confident 

about decisions they were planning to make, but they probably would not have altered 

their decisions based on duplicative information. 

Fifteen of the 20 responses had little chance of having an impact on decisions. Four 

responses were received after the boards’ decisions. Eleven responses, though 

received by boards before decisions were made, provided only information already 

known to the boards. , 

The remaining five responses were received prior to the decision and provided 

information unavailable elsewhere. These responses had the potential for having an 

impact on board decisions. 

� Five Data Bank responses arrived before State boards’ decisions were finalized 

and contained information that neither the practitioner involved nor any other 

sources had provided, but did not have an impact on State boards’ decisions. 

In four of these cases, the State boards granted full approval to the 

practitioners’ requests for licenses. In one case, a board denied a license for 

reasons unrelated to its receipt of information from the Data Bank. 

One practitioner about whom a board learned of new information from the Data 

Bank before making its decision had a long history of adverse incidents. The board 

knew of two incidents that occurred before the Data Bank opened, and these incidents 

were sufficient grounds to deny the practitioner’s application for a license. The 

board’s decision, therefore, was not affected by the receipt of still more damaging 

information from the Data Bank. 

7 
All four responses about practitioners who were ultimately granted licenses contained 

single reports of malpractice payments. The payment amounts ranged from $24,000 to 

$717,366. None of these practitioners informed the boards of the payments on their 

behalf, and each Data Bank response was considered useful by the board receiving it. 

Apparently, however, the boards decided that neither the practitioners’ actions leading 

to the malpractice suits nor the practitioners’ failure to disclose the payments 

warranted an adverse licensure decision. 

8 
CONCLUSION 

Most licensing boards have not queried the Data Bank. Among their reasons for not 

querying is that they already receive much of the information sent to the Data Bank. 

Our results suggest, however, that boards may be underestimating the value of 

querying the Data Bank. Two-thirds of the responses that nine boards have received 

to their queries have been considered useful, and several responses have provided 

information that the boards did not already have. 

Boards might make the best use of the Data Bank by querying in cases where 

information from out of State is needed, because boards are less likely to obtain 

information routinely from out-of-State sources than in-State sources. Boards could 

design targeting strategies with this in mind. For example, they could query about all 

practitioners who apply for licenses after practicing in other States. Or they could 

query about current licensees who also maintain licenses in other States. Meanwhile, 

they might choose not to query about practitioners seeking the first professional 

licenses of their careers, as these practitioners are unlikely to have been reported to 

the Data Bank. A period of experimentation with querying would probably help 

States determine how to make the most cost-effective use of the Data Bank. Boards 

might wish to repeat such experiments periodically, to see whether querying becomes 

more fruitful as the Data Bank continues to collect information. 

As we noted in the introduction, the Data Bank provides information even to those 

boards that choose not to query. Boards now automatically receive reports of all 

malpractice payments and hospital and professional society disciplinary actions 

occurring within their States. This function of the Data Bank has particular 

significance for boards in States without complementary reporting laws. 

9 
COMMENTS ON THE DRAFT REPORT 

From within the Department of Health and Human Services, we received comments 

on our draft report from the Public Health Service (PHS) and the Assistant Secretary 

for Management and Budget (ASMB). We also received comments from the 

Federation of State Medical Boards (FSMB) and the American Association of Dental 

Examiners (AADE). In appendix C, we reproduce these comments in full and provide 

our responses to them. 

The PHS found our report useful and had supportive comments. The PHS felt our 

title was somewhat misleading. We have added some information in our background 

to address this issue. 

The ASMB felt it was difficult to evaluate the findings based on a small sample. We 

note that the report was not based on a sample, but was based on the universe of 

matches at the time of the study. The ASMB also felt that we should include three 

recommendations in our report. As we explain in appendix C, we chose not to 

incorporate ASMB’S recommendations into our report. 

The FSMB felt the sample size was too small to allow us to make significant findings. 

They felt that it was premature to be doing a study of this sort. As noted above, the 

report was based not on a sample of matches, but on the universe of matches at the 

time of the study. While we agree that the experience is limited, we feel our study 

provides meaningful insight into the Data Bank’s utility. 

The AADE was also concerned about the size of the sample, particularly since only 

one dental board was represented. They suggested that the report distinguish between 

medical boards and dental boards. We have included more information in the 

introduction to clarify that most of the experience we base our conclusions on is from 

State medical boards. 

10 
APPENDIX A 

METHODOLOGY 

We collected the data presented in this report through a mail survey of State licensing 

boards conducted from February to July 1992. We surveyed the universe of all 

59 Data Bank queries from licensing boards between September 1, 1990, and March 

19, 1992, that resulted in matches. A match is a pairing of a report and a query to the 

Data Bank that name the same practitioner. The 59 queries matched a total of 68 

reports in the Data Bank. We requested and received from Paramax Systems 

Corporation a computer file containing records of all queries and reports received by 

the Data Bank that identified the same practitioner. We restructured and analyzed 

the data using Version 6.04 of the SAS System for Personal Computers. 

By April 1992, we had mailed a questionnaire about each query to the board involved. 

Thirteen boards received these questionnaires. Table A shows the response rate for 

each board. Analysis of nonrespondents showed no biases in favor of types of reports 

(adverse actions VS.malpractice payments) or dollar values of malpractice payments. 

Appendix B shows the questionnaire and simple frequencies of the responses. 

Five of the respondents’ queries matched two reports in the Data Bank. Therefore, 

our 44 returned surveys corresponded to 49 individual matches. 

With the exception of one dentist, all practitioners named in the 44 returned surveys 

were physicians. Eighteen queries matched reports of adverse actions and 26 matched 

reports of malpractice payments. The adverse actions consisted of 14 board 

disciplinary actions and 6 hospital privilege actions (2 queries matched 2 adverse 

actions each). 

A-1 
Licensing Board 

hska Board of Mediul Examiners 

Jaska Board of Dental Examiners 

bnnecticut Divisionof Mediml Quality 

Msurance 

~oridaDepartment of Professional 

{egulation 

owa Board of Medid Examiners 

Centuc& Board of MediMl L@nsure 

Louisiana Board of Mediml Examiners 

Missouri Board of Registration for the 

Healing ~ts 

Nevada Board of Mediml Examiners 

Number of 

Queries 

Resulting in 

Match= 

5 

1 

1 

24 

6 

1 

10 

5 

1 

Number of 

RepOr@ 

Matchd 

5 

1 

1 

26 

8 

1 

11 

Q0 

1 

3 

11 

1 

1 

68 

-1 

Number of 

Responses to 

OIG Sumq 

5 

0 

0 

17” 

3 

1 

10* 

5“ 

1 

0 

0 

1 

1 

44 

from the Missouri matched two Data 

2 New Jersey Board of Mediml Examiners 

1 Pennsylvania Board of Medicine 

1 Texas Board of Mediml Examiners 

1 Washington Mediml Disciplinary Board 

59 Total 

* Among the queries for which we received replies to our survey, three and one from the Louisiana Board Board, one from the Florida Board, 

Bank reports. Therefore, the total number of reports matched by queries in our sample is 

49 rather than 44. I 

A-2

APPENDIX B


sUMMARY OF LKENSmG BOWS’ RESPONSESTO OIG MAIL SURWY 

SERWU.S. D=MW~ OF =m AND ~ 

USE AND UTILITY OF THE 

NATIONL PRACTITIONER DATA BANK 

NOTE: The first23 questionsin thissurveyconcernthe caseof Doctor& whoseidentityis givenon the 

attached identifimtionsheet. Please confineyour responsesto your knowledgeof that particular case. 

BASIC FACTS AND CHRONOLOGY 

1 

1 What is Doctor A’s specialty? 18 difierent spectilhm repraented 2 

On what date did you request information about Doctor ——— //

A from the National Practitioner Data Bank? 

3 

On what date did you receive a response from the Data 1 I ——— If

Bank? 

what prompted you to request information about Doctor A from the A 

National Practitioner Data Bank? 

37 (a) Initial license application (Go to Question 5) 

3 (b) Renewal of license (Go to Question 6) 

4C () Inquiry or investigation (Go to Question 9) 

o (d) Other (Explain: 

) (Go to Question 13) 

5 

5	 (2hswer if you answered (a) to Question 4) //

On what date did Doctor A file an initial license ~s~tr 

a~plication? Question T) AA 

6 

6 (Answer if you answered (b) to Question 4) // 

On what date did Doctor A filea renewallicense — ——— — II application? 

B-1

7 

7 (Answer if you answered (a) or (b) to Question 4) 

on what date did the State board make its decision ,_ // _ 

about Doctor A’s licensure application or renewal? 

(Answer ~ you answered (a) or (b) to Question 4, then 

skip to Question 13) 

What was the decision on Doctor A’s license? 

22 (a) No decision reached yet 

13	 (b) License application approved or renewed 

without restrictions 

3 (c) License application rejected 

1 (d) Restrictions placed on license 

1 (e) Provisional or probationary approval given 

0 (f’) other (Explain: 

) 

— 

8 

9 

(Answer if you answered (c) to Question 4) .— // —
 On what date did the State board initiate an


investigation on Doctor A?


10 

10 (W.swer if you answered (c) to Question 4) //_— On what date did the State board close its investigation _ 

on Doctor A? (Write “OPEN’ if the case is still open.) 

B-2


--4 

9 
11 (Answer if you answered (c) to Question 4) 

What prompted the investigation? 

O (a) Consumer complaint 

O (b) Conviction in a criminal case 

1	 (c) Clinical privileges action by a hospital, HMO, 

other health care organization 

o (d) Peer retiew organization or Medicaid action 

O (e) Malpractice claim or payment 

3	 (f) Other (Specify: iquiry from another State 

board sumender of license in another State, repoti 

from FSMB) 12 

2	 (Answer if you answered (c) to Question 4) 

What was the result of the State board’s investigation? 

2 (a) No decision reached yet 

2 (b) Case closed without action 

O (c) License revocation 

O (d) License suspension 

O (e) License probation 

O (f) Other (Specify”“~ 

) 

B-3

AVAIUBILIW AND ACCURACY OF INFORMATION , 

I YES: 34 13 

Were you aware, from sources other than the Data NO: 10 

Bank, of the incident mentioned in the response from (If no, skip to 

the Data Bank and the subsequent disciplinary action or Question 15) 

malpractice payment? (Answer “NO”if the only 

information you received from other sources conskted of 

those sources’ repotis to the Data Bank.) 

From which of the following sources were you aware of the incident 1A 

and/or the subsequent disciplina~ action or payment? Aware OX 

Aware of Action/ 

Source kcident payment 

YES:29 YES:26 @ 

a,b Doctor A (self-report) 

YEs: 7 YEs: 5 q 

C,d Federation of State Medical Boards e yl?s: 12 YES: 8 

e,f Licensing board in another state 

YEs:o XEs:o g: 

g,h Malpractice insurer in your state 

YES:o ylfzs: o

i~ Malpractice insurer in another state 

k,l Hospital in your state yzs:1 YEs:1 k 

YES:2 YEs:o m,n 

m,n Hospital in another state 

Es: o YES:o O,p 

O,p Professional society in your state 

YEs:o ym: o q,r 

q,r Professional society in another state 

YES:1 YES:1 S,( 

S,t Other source in your state 

(IF YES, SPECIFY: 

)/ 

U,v Other source in another state 

XEs:1 yjqy: 1 u; 

(IF YES, SPECIFY: \ 

5 ~) H!zS: 15 

15 Was the information you received in the Data Bank NO: 37 

response inconsistent in any way with the information MISSING: 2 

received from any of the above sources? ) “~ (1F YES, WHICH SOURCES? 

M!?S:16 ~G 

16 Did you make additional inquiries to confirm the NO: 26 

accuracy of the Data Bank report or to obtain more MISSING: 2 

detailed information on its content (for example, from (If no, skip to 

reporting hospitals or insurers)? Question 18) u 

1 

13-4 
77VO: 

1 

YES: 16 17 

17 (Skip if you answered NO to Question 16) NO: O 

Did you find the information in the Data Bank 07HER 1 

response to be accurate? 

(1F NO, E~LAIN: One board was still waitig for 

infonnatin in respowe to i~ follow-up @u@.) YES: 15 18 

18 Were you aware of any incidents, disciplinary actions, or NO:28 

malpractice payments involving Doctor A that were ~ MISSING: 1 

contained in the response from the Data Bank? (If no, skip to II ‘Ouestion 22) 

MISSING: 

(Skip if you answered NO to Question 18) ONE: 5 

How many disciplinary actions and malpractice


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


the response from the Data Bank? FOUR 2


NINE: 1 

NONE: 13 zO 

(Skip if you answered NO to Questiotl 18) 

How many of these disciplinary actions and malpractice ~0: 2 

payments occurred after September 1, 1990? 21 

(Stip if you answered NO to Question 18) 

Which of the following sources provided information about incidents, 

disciplinary actions, or payments that were I@ contained in the 

response A from the Data Bank?

ES: 14 Doctor A (self-report) a 

ylzs:
 3 

b Federation of State Medical Boards 

c Licensing board in another state 

d Malpractice insurer in your state 

YEs:o d 

YES:o e 

e Malpractice insurer in another state 

YES: 6 

YES:o f 

f Hospital in your state 

YEs:2 g

Hospital in another state 

g YEs:o h 

h Professional society in your state 

o i 

i Professional society in another state ylzs: 

YEs:o j

Other source in your state j (IF YES, SPECIFY: 

) 

YES:o
 Other source in another state k 

(IF YES, SPECIFY: 

) 

B-5

UTILIW OF INFORMATION 

Overall, do you believe the information about Doctor A


contained in the response from the Data Bank was


useful to you?


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


8 

19 

3 

3 

6 

(a) Information was not available elsewhere 

(b) Information confirmed other reports that 

were available elsewhere 

(c) Information helped us to judge Doctor A’s 

competency 

(d) Information helped us to judge Doctor A’s 

professionalism 

(e) Other (Explain: ) 

IF NO, WHY NOT? (Cheek all that app~) 

13 (f) Information was available elsewhere 

0 (g) Information was not accurate 

1	 (h) Information did not help us to judge Doctor 

A’s competency or professionalism 

4 fi) Information was not provided in a timely - \/ 

manner 

0 (j) Other (Explain: )

) 

23	 Would the decision regarding Doctor A’s license or 

investigation have been different if you had @ queried 

the Data Bank? 

(IF YES, EXPLAIN: NOTE: Some boards that had not 

YES: 29 22 

NO: 15 

YEs: o 23 

NO: 36 

oXHER 1 

MISSING: 7 

yet reached final deckions nevetihelms answered that their 

dechions wouki not have been different had thq not 

queried the Data Bank) 

B-6

NOTE: The remaining questions do not concern the specific case of Doctor ~ but rather your 

general experience with and attitudes about the Data Bank. 

GENERAL QUESTIONS ON THE 

NATIONAL PRACTITIONER DATA BANK 

24 How, if at all, have the other parts of your licensing and investigation ~ 

procedures been affected by the availability of the Data Bank? 

Five boarb cited no ejJec@, generally. 7%ree boarck said that querying 

the Data Bank slowed down the licensure process. mO boarh noted 

that the Data Bank provided the boards with another usefi.dsource of 

hlfomlatl”on 

2s Under what circumstances have you queried the National Practitioner X 

Data Bank? (Check all that app~.) 

~ (a) All initial license applications 

~ (b) All license renewal applications 

& (c) All complaints and referrals 

_O_(d) All investigations and inquiries 

~ (e) Other (Speci@ All reachvatiom and reinstatements: 2 boards 

Some investigations and inquirim: 2 boards. Some lice~~e applications:1 

board Only one query ever: 1 board) 

26 What is the total number of queries you have made to Range: 26 

the Data Bank to date? 1- 5,000+ 

27 Please rank the following four types of information maintained in the 27 

Data Bank in terms of their usefulness to you--in practice or in 

theory--in the licensing and investigation process. (Let 1 = most 

useful and 4 = least use ful.) NOTE: Means were calculated mung one 

score per board not one score per response. 

a Hospital disciplinary actions/privilege restrictions MU: 1.5 a 

b Licensing board actions MM: 21 b 

c Malpractice payments AfEAIW 2.8 c 

d Professional society disciplinary actions Mm: 3.1 d 

B Is there any type of information currently maintained by the Data z 

Bank that you believe would ~ be useful to you under ~ 

circumstances? If so, please explain. 

All boards either answered “no” or did not respond 

B-7 
29	 What kind of information @ currently maintained by the Data Bank 29 

would be useful to you? 

One board suggested other States’ deniak of license applications, one 

suggested criminal recordr, and one suggmted tiformation regarding 

incidenfi that occumed before the Data Bank opened Other boards 

answered “none” or did not respond 

30	 Please list any additional comments and suggestions you have about so 

the National Practitioner Data Bank, especially those that pertain to 

its usefulness to State licensing boards. 

One board suggested that applicants be respow”ble for que@g the Data 

Bank and that responsm be sent automatical~ to the boaruk. One board 

asked that the reportingprocess be simplified One board commented 

that ~heData Bank’s respowe time was too slow. One board noted t~t 

it rarely queried because information in the Data Bank generally 

duplicated what the board already knew. One board said that because 

the tifotmation was duplicative, the six dollar que@ng fee was too higk 

One board predicted that the Data Bank wouki become more we~ to 

boarh if and when it collecti information about practitioner other than 

physJ”ciansand dentkts. Three boards dti not respond 

B-8


— —�
APPENDIX C 

DETAILED COMMENTS ON THE DRAFT REPORT AND 

OIG RESPONSE TO THE COMMENTS 

In this appendix, we present in full the comments on the draft report offered by the 

Public Health Semite (PHS), the Assistant Secretary for Management and Budget 

(ASMB), the Federation of State Medical Boards (FSMB), and the American Association 

of Dental Examiners (AADE). We also present our response to each set of comments. 

c-1 
—- —.—

PublicHealthServi~ 

DWWT~T OF HEAL~ & HUM SERWCES 

Memorandum 

“ IJEC241992 

Deputy Assistant SecretarY for Health Managaent Operations 

Office of Inspector General (OIG) Draft Report “National Usefulness of Reports to State Practitioner Data Bank: 

Licensing Boardsr 0EI-01-90-O0523 , 

0s 

Deputy Inspector General for Evaluation and Inspections, 

on the subject AttaChed are the Public Health ‘e~ice coment~ontributes to 

draft OIG report. we bel~eve that the report on the “=~~ly” Data . the growhg positive evaluative litaratlar~ 

7* 

Anthony L. lt “ 

Attactient 

c-2 
PUBLIC HEALTH SERVICE fPHS~ COMMENTS ON THE OFFICE OF 

INSPECTOR GENERAL (OIG) DIUU?T REPORT “NATIONm 

PRACTITIONER DATA BANK: USEFULNESS AND IMPACT 

OF REPORTS TO STATE LICENSING BOARDS” 

The OIG performed this study to assess the uti-li.ty of National 

Practitioner Data Bank (NPDB) reports to State li-censi.ng 

boards. In this study, OIG focussed on the experiences of a 

small group of State boards who queried about practitioners 

who had in fact been reported to the NPDB. OIG sought to 

determine why these boards elected to query the NPDB, whether 

they found the information the NPDB provided useful, anti what 

impact the information had on the board proceedings. 

The OIG found that most NPDB responses were useful to State 

kmar~s; however ~ the rqoxts never led the boards to make 

licensure or disciplinary decisions that they would not have 

made even without the reports. OIG concludes that boards 

might xnake the best use of NPDB reports by querying in cases 

where information from out-of-state is needed. 

We believe that the OIG report represents a contribution to 

the growing positive evaluative literature on the “early” 

NPDB. However, some readers of the report may be misled by 

the report’s subtitle which suggests that the study’s findings 

are generalizable to all State licensing boards. We suggest 

that the report emphasize that query matches involving only 

13 State boards were the basis of the study. 

Technical Comment 

There is a minor omission in the first sentence of the first 

full paragraph on Page 5. The introducto~ clause of that 

sentence should read: “Timeliness is an important factor in 

the usefulness of the Data Bank . ...” 

c-3 
OIG RESPONSE TO PHS COMMENTS 

The PHS suggested that the title of the report might mislead readers to believe the report 

was generalizable to all State licensing boards when in fact it was based on the 

experiences of only 13 boards. Because our report is based on a sumey of all State 

licensing boards that had had matches as of March 1992 and thus represents fully this 

universe, we have not changed the title. We have, however, added information in the 

background section to emphasize that this is an early look at the Data Bank. 

c-4 
�

�

� 

� 

,?@vms ~, 

f

4+ - of the SecretW 

:. DEPARTMENT OF HEALTH& HUMAN SERVICES : 

2 ~ %

% Washington, D.C. 20201 

‘%v,la >

NW I!3IWL


MEMOWD~ TO:	 Bryan B. Mitchell 

Principal Deputy Inspector General ~ 

FROM Arnold R. Tompkins 

Assistant Secrets ~sm~anw 

h 

SUBJECT � OIG Draft Report: llNational practitioner Data 

Bank: Usefulness and Impact of


Licensing Boards, It OE1-ol-gO-00523 Reports to State


Thank you for the opportunity to review your draft report, il??atlonal practitioner i)ata i3anlc: Usefulness and Impact of

Reports to State Licensing Boards.” 

i.nformati.on provided in your report 

somewhat difficult evaluating the 

the small sample. We do agree that 

the majority of Data Bank Reports 

We think that the Data Bank provides

to increase 

Overall, we have found the 

very use~ul, although ~t WaS 

findings of the report given those who were surveyed found 

to be useful. 

a	 very valuable service and the usefulness of these suggest that PHS find ways 

reports to State Boards. 

comments and recommendations Therefore, we provide the following 

for your consideration. 

If your staff have any questions about this response, please have 

them call Neil J. Sti.llman, Deputy Assistant SecretarY for 

Information Resources Management, at 690-6162, or Joanne Amato, 

Office of Information Resources Management, at 690-8358. 

At~~Chment 

C-5

OIG Draft Re~ort 

‘tNational Practitioner Data Bank: 

Usefulness and Im~act of Reports to State Licensincf Boards’s 

We have found the information provided by your report accurate 

and useful, although it was somewhat difficult to evaluate the 

findings of the report given the small sample. We do agree that 

most Data Bank reports were useful to State Boards included in 

your survey. 

Based on information contained in the report, we agree that 

Boards might make the best use of the Data Bank by querying h 

cases where information from out-of-State i.s needed, since the 

boards are less likely to obtain this information routinely. We 

also agree that timeliness is an important factor in determining 

the usefulne~~ GZ reports, although it does not seem to be as 

significant a problem for State Licensing Boards as for 

hospitals. We also believe that these reports, in general, Could 

be more useful i.f Boards were required to qubry the Data Bank h 

certain instances. Given this, we suggest that you provide 

recommendations to PHS as part of your report and offer the 

following: 

PHS is currently in the process of determining priorities 

and strategies for procuring its second contract for 

administration of the Data Bank. We suggest that PHS work 

with Data Bank customers i.n defining addi.ti.onal data needs 

(possibly focusing on out-of-State information) that will 

increase the. usefulness of these reports, as part of the new 

system design requirements. 

Likewise, we strongly recommend that PHS make improving 

query response time a high priority. It is our opinion that 

the new system design should support a virtually paperless 

environment and provide interactive access to the user. We 

believe that this type of design will not only cut down on 

errors significantly, but can also reduce costs and increase 

the timeliness of responses to our customers. 

We suggest that PHS seek legislative authority requiring 

State Licensing Boards to query the Data Bank for first-time 

license requests and for applicants who have practiced 

in another State. 

C-6 
OIG RESPONSE TO ASMB COMMENTS 

Although we agree with the general thrust and many of the specifics of ASMB’S suggested 

recommendations, we have not incorporated them into our report. We believe that PHS’S 

work with the Data Bank Executive Committee and regular communications with user 

groups constitute sufficient efforts to identify additional data needs. (Furthermore, the 

State licensing boards we surveyed were given the opportunity to identi~ useful additional 

data, but no type of data was identified more than once.) We believe that PHS should 

make improving response time a high priority; we note that we made a recommendation 

to this effect in our report entitled “National Practitioner Data Bank: Usefulness and 

Impact of Reports to Hospitals” (OEI-01-90-00520). Finally, while we feel that our report 

shows that the Data Bank is potentially a useful source of information for State licensing 

boards, particularly about applicants who have practiced in another State, we do not feel 

our evidence warrants a recommendation that PHS propose legislation requiring boards 

to query. We feel that since our report is based on early evidence from very few boards, 

we should not make anything more than suggestions about whether boards should query 

and when they should query. 

c-7 
2 February 1993 

THE FEDERATION OF 

SZ4TE MEDICAL BOARDS 

OF THE UNITED S’ZAm INC 

6000 WESTERN PLACE 

SUITE 707 

FORT WORTH, TEXAS 

76107-4618 

817735-8445 

FAX 817738-6629 

OFFICERS 

PRESIDENT 

MELVINE. SIGEL, MD 

2211 PARK AVENUE SOUTH 

MINNEAPOLIS, MN 55404 

PRESIDENT ELE~ 

HORMOZ RASSEKH, MD 

201 RIDGE STREET, #lOS 

COUNCIL BLUFFS 1A 51503 

VICE PRESIDENT 

GERALD J. BECHAMPS, MD 

P. O. BOX 2698 

WINCHEWER, VA 22601 

TREASURER 

SUSAN M. SPAULDING 

P. O. BOX 222 

MONTPELIER, VT 05601 

DIRECTORS 

BARBARA S. SCHNEIDMAN, MD 

140 LAKESIDE AVE., #200 

SEATTLE. WA 98122 

LEROY B. BUCKLER, MD 

640 SOUTH STATE SREET 

DOVER, DE 19901 

RENDEL L. LEVONIAN, MD 

P. O. BOX 756 

PICO RIVERA, CA 90660 

RAYMOND J. ALBE~ 

7505 BUNKERHILL RD. 

AMANDA, OH 43102 

JOHN T. HINTON, DO 

P.O. BOX 338 

COLLEGE CORNER, OH 4S003 

ROBERT 1?. PORTER, MD 

ONE MEDICAL CENTER DRIVE 

LEBANON, NH 03756 

STEPHEN P. KELLEY. JD 

16CKITCF TOWER 

MINNEAPOLIS, MN 5S402 

JAMES E. WEST, MD 

411-D EASI’ 9TH ST. 

ANN1SIT3N, AL 36201 

STEPHEN S. SEELING, JD P.O. BOX 12245 

COLUMBIA.SC 2921I 

JAMES R, WINN, MD 

EXECUTIVE VICE PRESIDENT 

David R. Veroff 

Project Leader 

Office of Inspector General 

Office of Evaluation and Inspections 

Region 1 

John F. Kennedy Federal Building 

Bosto~ MA 02203 

Dear Mr Veroff 

I appreciate the opportunity to comment on the OIGS draft report titled 

National Practitioner Data Bank: Usefulness and Impact of Reports to 

State Licensing Boards. I have also reviewed the accompanying report 

related to hospitals but will not comment directly on that, save to suggest 

that it appears a more useful effort. 

To begin, I agree with the basic thrust of the report related to the state 

boards: that the NPDB can be a valuable tool for any entity that must 

review physician credentials and should be as widely used as possible. At 

the same time, I recognize, as you do, the limitations of the bank 

stemming from its shallow reservoir of data. As you remark this will 

change as years pass. You are also correct in pointing out the bank’s value 

as a potential resource for research in the liability area. Clearly, and for 

obvious reasons, its role in relation to state board actions is redundant, but 

that does not detract from its value as a source of information for boards 

on privileging and liability actions taken in other states. 

However, as I noted in my comments to the Executive Committee in 

December, the data presented in this report are so sparse that their use to 

demonstrate any point reliably is simply not tenable by any reasonable 

standard. The study was certainly premature and its conclusions, because 

of that, are of doubtful utility. The most significant points deriving from 

the data, in fact, are that few state boards are yet (as of the date of the 

study) using the NPDB and that the bank’s response time must be 

improved for it to be of significant value in decision making. Beyond that, 

the data camot go. And simple common sense has told us both those 

things for some time. 

I suggest that a study of this type might better be done after more 

extensive NPDB experience has accumulated, and that this original effort 

DALE G BREADEN 

ASSOCIATE EXECUTIVE 

VICE PRESIDENT 

1. KATHRYN HILL, MEd 

ASSI~ANT EXECUTIVE 

VICE PRESIDENT C-8 
Page 2 

2 February 1993 

David R. Veroff 

be put aside. If, indeed, the purpose of the report, as stated at its beginning, is to study the 

utility of NPDB reports to state licensing boards, it fails for being too small a sample taken 

too soon. 

Sincerely 

7’7J , * 

James R. Wi~ MD 

Executive Vice President 

JRW:lV 

c-9 
OIG RESPONSE TO FSMB COMMENTS 

We agree that State licensing boards’ experiences with Data Bank reports are limited. 

However, we feel that it is worthwhile to assess their experiences thus far to provide early 

insights on an important function of the Data Bank. We note that the report is based on 

a sumey of ~ boards that had matches at the time of the study. As such, it represents 

the universe of boards’ experiences with reports from the Data Bank. Because boards’ 

experiences have been limited, we do not recommend mandated action by PHS, Congress, 

or boards, but instead suggest that boards consider certain actions in light of their needs 

(we note that others felt our results indicated the need for mandates). The FSMB also 

contends that the most significant points deriving from the data were self-evident. We 

disagree; we believe the information on usefulness and impact to be new and valuable 

information particularly at this early juncture. We do agree, however, that our 

examination comes early in the history of the Data Bank. We have added text in the 

introduction to emphasize the fact that this inquiry was intended to be an early look at 

how State licensing boards have used and perceived the usefulness of Data Bank reports. 

In the introduction, we also more clearly describe the scope of the report. 

c-lo 
--

AMERICAN ASSOCWTION OF DENTAL EXAMINERS 

211 E. Chicago Ave., Suite 644, Chicago, IL 60611 (312) 440-7464 

January 18, 1993 

FRBsrDm 

Dr. Wayne J. Barnes 

2928 Hamilton Boulevard 

Sioux City, IA 51104 

(7 12) 255-7607 

pRmmlNT-EUm’ 

m. Joel F. Glovcr 

3605 Grant Drive 

Rcno, NV 89509 

(7o2) 825-2417 

FIRST VICE~~W 

Dr. Lillian H. BachnuMI 

30 East 60ch Street 

New York, NY 10022 

(212) 755-0125 

SECONDVICE-PRWDW 

Dr. Ken C. Crawley 

440 Broad S1. 

Columbit% MS39429 

(6ol) 736-1761 

THIRD Vlm-mmmm 

Dr. Harry R. Dominen 

2860 Piedmont Avenue 

Duluth, MN 55811 

(218) 722-0823 

IMMEDIATE PAST PRBSIDENT 

m. Robert T. Ferris 

475 Maitland Avenue 

Ahamont.eSprings, FL 32701 

(4o7) 831-1747 

IMKUTIVE DIR.IKXOR 

Ms. Molly Nadler 

211 E. Chicago Avenue 

Suite 844 

Chicago, ~ 60611 

(312) 440-7464 

EDITOR 

m. Kathleen Kelly 

44 E. Mifflin Sk&t 

Suite 204 

Madiso% WI 53703 

(608) 256-049 

Mr. David Verof f


Project Leader


Department of Health and Human Services


Office of Inspector General


Office of Evaluation and Inspections


JFK Bldg.


Room 1407


Boston, MA 02203


Dear David:
 *


Thank you for giving the American Association of 

Dental Examiners the opportunity to comment on the 

OIG’S October 1992 draft report “National 

Practitioner Data Bank: Usefulness and Impact of 

Reports to State Licensing Boards.” Most of the 

AADE comments were transmitted to you by telephone 

or during the National Practitioner Data Bank 

Executive Committee Meeting, December 14, 1992. 

The report stated, “From the opening of the Data 

Bank in September 1990 through March 19, 1992, 

there were 59 queries from boards that matched a 

total of 68 reports about practitioners in the 

Data Bank. Thirteen different agencies submitted 

these queries: 11 medical board% 1 dental board~ 

and 1 umbrella agency representing several state 

boards.” In my opinion, this is an extremely 

small sample from which to draw any conclusions 

especially regarding usefulness of the NPDB for 

the dental boards. Also, i.t is suggested that 

comments distinguish between medical and dental 

boards in the report. 

In addition, I agree with comments made at the 

NPDB Executive Committee Meeting by Dr. Jim Wynn, 

Federation of State Medical Boards’ Executive 

Director, that an important question was missed in 

this study why state boards do not query the 

NPDB . Possibly another study could be done when 

more boards have queried that would address the 

cost versus benefit ratio to the boards. 

Again, thank you for allowing the AADE to comment. 

Sincerely, 

4 

Molly Nadler 

Executive Director 

cc : Members, Executive Council 

C-II 
--

OIG RESPONSE TO AADE COMMENTS 

We agree that it is difficult to judge the usefulness of the information in the Data Bank 

to State dental boards based on the experience of one board with one match. We note, 

however, that we did not draw a sample of the matches, but instead looked at the 

universe of matches. Our conclusions are based on all of the experiences boards had had 

with reports at the time of the study. Therefore, while we have added information in our 

background that emphasizes that most of the experiences with reports have been comes 

from medical boards, we have not made changes to findings or to the conclusion. 

The AADE notes that we did not address an important issue in our study why State 

boards frequently do not query the Data Bank. We agree that this is an interesting and 

important question, but note that it was beyond the scope of this study. 

C-12 
APPENDIX D 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

NOTES 

Actions that must be reported include: adverse decisions on hospital privileges 

including voluntary resignation; actions taken by State licensing boards on 

licenses including suspension, denial, restriction, and revocation; and losses of 

membership in professional societies. 

As of March 30, 1992, only 40 of the more than 130 medical, osteopathic, 

dental, and other State boards had submitted queries. 

As of March 19, 1992, there were 69 matches. According to HRSA, there were 

9,813 queries from State licensing boards as of March 30, 1992. 

The match rate is expected to increase over time as more practitioners are 

reported to the Data Bank. 

P.L. 99-660, Sec. 402. 

M. Holoweiko, “The malpractice data bank is turning into a Frankenstein,” 

Medical Economics, May 6, 1991, pp. 120-133. 

In the other two cases, the practitioners themselves provided boards with 

information that the Data Bank did not provide. 

Response time is defined as the time a board had to wait between submitting a 

query to the Data Bank and receiving a report. 

For a more thorough discussion of the Data Bank’s response time, see the OIG 

report, Nah”onal Practitioner Data Bank: Usefulness and Impact of Repotis to 

Hospitalk (OEI-01-90-00520), forthcoming. 

In the five cases where respondents had received two reports in response to 

their queries, the pairs of reports were extremely homogeneous. ln all five 

cases, both reports provided information from sources outside the State in 

which the querier was located. In three cases, both reports involved 

malpractice payments; in the other two cases, both reports involved adverse 

actions. All malpractice payments in these responses were for amounts greater 

than $50,000. The only differences between paired reports relevant to this 

study concerned types of adverse actions. One response contained a pair of 

reports submitted by hospitals, but the other contained one report submitted by 

a hospital and one report submitted by a licensing board. In constructing 

table 1, we included this split pair as 1 of the 13 responses involving board 

licensure actions. Had we included the pair as a response involving hospital 

D-1 
privilege actions, the proportions of responses considered useful for these two 

types of adverse actions would have been even more similar. 

D-2