...

Department of Health and Human Servces 

OFFICE OF 

INSPECTOR GENERAL 

NATIONAL PRACTITIONER DATA BANK: 

PROFILE OF MATCHES 

S'ERVIC1" 

'0 

o,d'3a 

Richard P. Kusserow 

INSPECfOR GENERA 

APRI 199 
OFFICE OF INSPECTOR GENERA 

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 Servces' (HHS) programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and inspections conducted by three OIG operating components: the Offce of Audit Services, the Offce of Investigations, and the Offce 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 SERVICE 

The OIG's Offce of Audit Servces (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 

carryng out their respective responsibilties 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 effciency throughout the Department. 

OFFICE OF INTIGATIONS 

The OIG's Offce of Investigations (01) conducts criminal, civil, and administrative investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 

unjust enri hment by providers. The investigative efforts of 01 lead to criminal convictions 

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

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

OFFICE OF EVALUATION AN INSPECTONS 

The OIG's Offce 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 effciency, vulnerability,

and effectiveness of departmental programs. 

This report was prepared in the Boston Regional offce under the direction of Regional 

Inspector General Mark R. Yessian, Ph. , and Deputy Regional Inspector General Martha B. Kvaal. Project staff include: 

David Veroff Project Leader 

David Schrag, Lead Analyst 

Alan Levine Headquarters 
...

Department of Health and Human Servces 

OFFICE OF 

INSPECTOR GENERAL 

NATIONAL PRACTITIONER DATA BANK: 

PROFILE OF MATCHES 

..SEIWIC't.. 

'0 

'lb'''dia 

Richard P. Kusserow 

INSPECTOR GENERAL 

OEI-Ol-90-O522 
EXECUTIVE SUMMAR Y


PUROSE 

Ths report profiles the set of occasions--known as matches--on which the National 

Practitioner Data Bank has provided records of malpractice payments or adverse 

actions to queryng entities. 

BACKGROUN 

The National Practitioner Data Bank opened on September 1, 1990. It maintains

records of malpractice payments (both judgments and settlements) and adverse actions 

against licensed health care practitioners. The Data Bank provides hospitals and other 

health care entities with information relating to the professional competence and 

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

receives reports of adverse actions against practitioners from State licensing boards 

hospitals and other health care entities, and professional societies. It receives reports 

of malpractice payments from malpractice insurers. 

The Data Bank has received approximately 1 000 000 requests for information 

(referred to as "queries ) and 25 000 reports of adverse actions or malpractice 

payments. When a query names a practitioner who has been reported to the Data 

Bank, the query-record pair is referred to as a "match. 

The Office of Inspector General analyzed all Data Bank matches through March 19 

1992, in preparation for a study on the use and utility of the information stored in the 

Data Bank. This analysis yielded rich information about the Data Bank' s history that was unavailable elsewhere. To make available this information, which we believe may affect the management of the Data Bank, we are providing in this report a profile of all matches. The report answers some basic questions about the Data Bank' 

operations. The statistics presented do not reflect the use or utility of the information 

obtained by queriers through matches. Our forthcoming report, however, will put these statistics in context. We will survey a sample of queriers who have had matches

and determine what tyes of matches are most valuable. 

FIINGS 

As of March 19, 1992, 954 matche ha occued Almt all of the involved 

hoitals receig informtin about physin'. 

In 93 percent the practitioner involved was a physician.


In 91 percent the querier involved was a hospital. 
In 88 peen of matche, the innt involved was a malpractie pa; th other 

12 percent involved adverse actino. 

Half of the malpractice matches involved payments of $50 000 or less; most involved recent incidents. 

Licensing boards and hospitals each accounted for about half of the adverse 

action records involved in matches. 

Nrn peen of matche involved prctine who cred Slale li seekig work 

APPENICE 

In four appendices, we provide details on the tyes of practitioners, queriers malpractice payments, and adverse actions involved in matches. 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .......................................... 

TABLE OF CONTENTS€

PAGE€

EXECUTIVE SUMMAY€

INRODUCTION. . . . . . . € . . . . . . 1


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

How many matches have occurred to date? ........................... 3 

What kinds of practitioners have been involved in matches? ............... 3 

What kinds of queriers have had matches? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

What kinds of reports have resulted in matches? ....................... 4 

Has the Data Bank supplied information on practitioners 

who crossed State lines? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5€

APPENDICES€

A. Practitioners Involved in Matches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AB. Queriers Involved in Matches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. BC. Malpractice Payment Records Involved in Matches. . . . . . . . . . . . . . . . . . . .. CD. Adverse Action Records Involved in Matches. . . . . . . . . . . . . . . . . . . . . . . . . DE. Notes ............... ...................................... E-

INTRODUCTION 

PUROSE 

This report profies the set of occasions--known as matches--on which the National 

Practitioner Data Bank has provided records of malpractice payments or adverse 

actions to queryng entities. 

BACKGROUN 

The National Practitioner Data Bank maintains records of malpractice judgments and 

adverse actions against licensed health care practitioners. It was established by Title 

IV of the Health Care Qllality Improvement Act of 1986 (P.L. 99-660), and has been in operation since September 1, 1990. The Data Bank is funded by user fees and 

Federal outlays and is administered by Unisys Corporation under contract to the 

Health Resources and Servces Administration (HRSA) of the Public Health Servce 

(PHS). 

The Data Bank provides hospitals and other health care entities with information 

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

health care practitioners. Congress believed it could, among other things, help 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. 

DEFION OF TERMS USED IN THS REPORT 

REPORT	 Information sent to the Data Bank about a 

practitioner by a malpractice insurer, hospital 

licensing board, or professional society. 

RECORD A report that has been received and is 

permanently stored by the Data Bank. 

QUERY A request for information about a practitioner 

submitted to the Data Bank by a hospital 

licensing board, or other health care entity. 

MATCH A pairing of a record and query that identifies 

the same practitioner. 
Reports of adverse actions against practitioners are submitted to the Data Bank by 

State licensing boards, hospitals and other health care entities, and professional societies? These groups must report actions against physicians and dentists, and health care entities and professional societies may report actions against other licensed 

practitioners. Reports of malpractice payments are submitted by insurers, who must report all judgments and settlements made on behalf of all licensed practitioners. 

Data Bank records may be released only to authorized entities. These entities 

(referred to as "queriers ) include hospitals and other health care entities 4 State 

licensing boards, professional societies, and, under specified conditions, plaintiffs attorneys in malpractice suits. Also, practitioners may request their own records. 

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

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

all practitioners with privileges.


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

certain practitioner from the Data Bank, and that practitioner has been reported to the Data Bank, the query-record pair is referred to as a "match. " Through November 

, 1991 (the most recent date for which complete statistics are available), the Data 

Bank had received 959 753 queries and 23 396 adverse action or malpractice payment 

reports.6 These queries and reports had resulted in approximately 9 

000 matches. 

The Offce of Inspector General analyzed Data Bank matches in preparation for a 

study of the use and utilty of the information stored in the Data Bank. This analysis 

yielded rich information about the Data Bank's history that was unavailable elsewhere. 

To make available this information, which we believe may affect the management of 

the Data Bank, we are providing in this report a profie of all matches through March 

, 1992. The report answers some basic questions about the Data Bank' s operations. 

The statistics presented in this report do not reflect the use or utility of the 

information obtained by queriers through matches. Our forthcoming report, however€ will put these statistics in context. We will survey a sample of queriers who have had

matches and determine what tyes of matches are most valuable. 

METHODOLOY 

The Offce of Inspector General (OIG) requested and received from Unisys Corporation a computer fie containing records as of March 19, 1992, of all queries and reports received by the Data Bank that identified the same practitioner.8 We 

restructured and analyzed the data using Version 6.04 of the SAS System for Personal Computers.9 We also obtained statistics pertaining to all reports and queries received 

by the Data Bank, whether or not they were involved in matches, as of November 22 1991. This information was not available through March 1992. Our review was 

conducted in accordance with the 
 Interim Standards for Inopections 
 issued by the President' s Council on Integrity and Efficiency. 
FINDINGS€

HOW MA MATCH HAVE OCD TO DATE? 

954 as of March 19, 1992€

Between September 1, 1990, and March 19, 1992, a total of 20 954 records of adverse€

actions or malpractice payments were sent to Data Bank queriers. In addition, there€ were a number of " choes" (in which a querier receives information it had previously 

submitted), duplicate records, and duplicate queries.lO None of these (1 939 matches 

in all) constituted a real transfer of information, and thus they are not included in any 

of our statistics.u€

The 20 954 matches resulted from 19 034 queries. This means that each query 

involved in a match provided the querier with an average of 1.0 (20 954 + 19 034) records per practitioner. 

The number of matches increased sharply between November 1991, when there were 

about 9 000 matches, and March 1992.1 Much of that increase is due to 

improvements made by the Data Bank administrators in resolving partial matchesY 

The Data Bank project officer estimated that 8 000 partial matches were resolved in€ February and March 1992 and that most of these resulted in matches.14 Prior to€

February 1992, the Data Bank had no mechanism for resolving these matches. 

WHT KIS OF PRACll'1 0NERS HAVE BEEN INOLVED IN MATCH? 

Nearl all are physicino.€

There were 10 185 different practitioners represented in matches,1 Ninety-three 

percent of the matches involved physicians (18 257 involved allopathic physicians and€

161 inv01ved osteopathic physicians); 4 percent involved dentists. Appendix A€

displays the tyes of practitioners involved in matches.€

Physicians are apparently overrepresented in matches. Just 75 percent of the reports€ submitted to the Data Bank involved physicians, compared with 91 percent of the 

matches. 16 This disparity is likely explained by the fact that hospitals are the only 

mandated queriers of the Data Bank and are most likely to query about physicians. 

WHT KIS OF QUERS HAVE HA MATCH?


Nearl all are hopitals.€

A total of 4 357 queriers submitted queries that led to matches. A vast majority of the 

matches resulted from queries submitted by hospitals (91.2 percent). Health 

maintenance organizations and preferred provider organizations accounted for 
3 percent and other health care entities for 1.8 percent. The remaining 0.6 percent were distributed among State licensing boards, group practices, and professional societies. (Appendix B displays these figures in tabular form.) These proportions are 

not unexpected. Hospitals are the only organizations required to query the Data 

Bank. Other organizations that may be interested in queryng in the future have 

various reasons for not doing so at this timeP 

Most of the 19 122 hospital matches resulted from mandatory two-year queries 

(64.3 percent). Initial privileging and employment queries accounted for 33.9 percent and professional review activity accounted for 1.6 percent. 

Most queriers had matches on a small number of practitioners; the mean was 4. 

practitioners matched per querier. Thirt-two percent of queriers matched on exactly 

1 practitioner, and 76 percent matched on 5 or fewer. A few queriers matched on 

many more practitioners; 1 health pJan had matches on 134 different practitioners.€

WHT KIS OF REPORTS HAVE REULTED IN MATCH? 

Nearl all are malpractie pay; just 12 peent are board, health care ent, or profesnal socti. 

adverse actin' of lien'g

A total of 938 reporters have submitted 11 296 adverse action or malpractice reports 

that have been matched. Malpractice payment records made up 88 percent of all 

the matches; adverse actions made up 12 percent. The corresponding percentages for all reports to the Data Bank were 85 and 15. 

Half of the malpractice matches involved payments of $50 000 or less; most 

involved recent incidents. 

Malpractice payment amounts ranged from $1 to $4 675 000, with a mean of 

$132 358. Most matches involved payments well below the mean; the median 

payment amount was only $50 000. 

Most matches involved fairly recent incidents of malpractice. Fifty-three percent 

involved incidents occurring in 1987 or later (including 11 that were erroneously 

reported as occurring after 1992). The earliest incident involved in a match occurred in 1961.23 

A majority of the malpractice records that appeared in matches fell into three major 

categories of acts or omissions: 32 percent were surgery-related, 28 percent diagnosis- related, and 19 percent treatment-related. Appendix C summarizes the tyes of acts 

or omissions. 
Licen'ing boards and hospitals each accounted for about half of the adverse 

action records involved in matches. 

Adverse action records appearing in matches came from two major sources. Fiftytwo percent came from licensure actions submitted by State boards and 47 percent 

from hospital clinical privileges actions. The remaining 1 percent came from 

professional societies reporting about membership actions. 

Overall, 71 percent of adverse action reports received by the Data Bank were 

licensure actions and 28 percent were clinical privileges actions.24 One hypothesis to 

account for the difference between the match proportions and the reportng proportions is that practitioners who have serious licensure actions taken against them 

may refrain from seeking credentials. If they do refrain, their records will not be 

requested and they will not be involved in matches. 

The specific actions taken against practitioners that show up in matches include 

probation of license (23 percent of adverse action matches) and denial of clinical 

privileges (12 percent). The reasons for action include incompetence, malpractice and negligence (16 percent of adverse action matches), unprofessional conduct 

(11 percent), and alcohol and other substance abuse (10 percent).25 Appendix D 

summarizes the tyes of actions and reasons for actions. 

HA TH DATA BAN SUPPLID INORMTION ON PRAcunONERS 

WHO CROSED STATE LIN? 

It ha happene 956 ti; ie., in 9.3 percen of all matche. 

One of Congress s priorities in establishing the Data Bank was to prevent incompetent 

and unprofessional practitioners from evading detection by simpJy crossing State lines. 

Interstate matches account for 9.3 percent of the total.26 
APPENDIX A€

PRACfITIONERS INVOLVED IN MATCHES 

SEPTEMBER 1, 1990 - MACH 19, 1992 

TYE OF PRAcrmoNER€ NUMBER OF PERCENTAGE OF 

MATCHES MATCHES 

TOTAL 

Physicians and Dentists 

Allopathic Physicians€

Allopathic Physician Residents€

Osteopathic Physicians€

Osteopathic Physician Interns and Residents 

Dentits 

Dental Residents€

Podiatrits 

Psychologists 

Other Health Care DisciplineslPersonnel 

Chiropractors 

Optometrts 

Physician Assistants€

Podiatrc Assistants€

Professional Counselors

Professional Counselors, Family/Marrge

Nurses and Related€

Regitered (Professional) Nurses 

Nurse Anesthetits€

Nurse Midwives 

Psychiatrc Technicians€

Emergency Care Personnel 

Rehabiltation!estorative Servce Personnel€

Technicians and Technologists€

Not Properly Coded 

954 100. 

20, 165 96. 

038 

219 

135 

735 

178 

DATA SOURCE: National Practitioner Data Bank. ANALYSIS: HHS Offce of Inspector General 

2.3 
. 

 

ApPENDIX B


QUERIERS INVOLVED IN MATCHES 

SEPTEMBER 1, 1990 - MACH 19, 1992 

TYE OF QUERIER NUMBER OF MATCHE PERCENTAGE OF 

TOTAL 

Non-Federal Hospital 

Initial privilegig/employ,,,mt 

Mana/ory two-year review 

Professional review activity 

Other€

Slate Licensing Board:€

HMO/pPO 

Initial privilegig/employment 

Mana/ory two-year review 

Professional review activity 

Other 

Other Non-Federal Health Care Entity 

Inil privilegig/emploYl1nl 

Mana/DIY two-year review 

Professional review activity 

Other€

State Licensing Board:€

Federal Hospital 

Initial privileging/emploYl1nt 

Mandatory two-year review 

Professional review activity 

State Licensing Board 

Stale licensing board 

Mandatory two-year review 

Inital privilegig/employment. 

Group Practice 

Professional Socety 

Other Federal Health Care Entity 

MATCHE 

954 100. 

788 89. 

6,278 

12,164 

301 

319 6.3 

776 

158 

350 

382 1.8 

257 

III 

334 1.6 

202 

127 

0.3 

DATA SOURCE: National Practitioner Data Bank. ANALYSIS: HHS Offce of Inspector General 

Denotes inconsistency between queryng entity ty and query ty; could result from improper form completion

or incorrect asignment of entity ty code.
APPENDIX C€

MAPRACTICE PAYMENT RECORDS INVOLVED IN MATCHES 

SEPTEMBER 1, 1990 - MACH 19, 1992 

TYE OF NUMBER OF PERCENTAGE OF PERCENTAGE OF ACT/OMISSION . MATCHE MAPRACTCE ALL MATCHES 

TOTAL MATCHES 

TOTAL 

MAPRACTCE 

MATCHES 

Surgery-Related 

Diagnosis-Related 

Treatment-Related 

Medication-Related 

Obstetrics-Related 

Anesthesia-Related 

Monitoring-Related 

Intravenous and Blood 

Products-Related 

Miscellaneous 

Biomedical Equipment/ 

Product-Related 

Not Properly Coded 

RECORD 

MATCHES 

954 100. 

521 100. 88.4 

871 31.7 28. 

125 27. 24. 

440 18. 16.4 

335 6.4 

286 

583 

235 

220 1.2 1.0 

206 1.0 

121 

0.5 

DATA SOURCE: National Practitioner Data Bank. ANALYSIS: HHS Offce of Inspector General 

Malpractice payment reports can be given one or two codes indicating 

ty of act or omission. Of the 18 malpractice payment matches only 4 521 088 were asigned two codes. For clarity, thes secondary codes have been disregarded in this table. 

C - 1 
MAPRACTCE PAYMENT RECORDS INVOLVED IN MATCHES€

SEPTEMBER 1, 199 - MACH 19, 1992€

MAPRACTCE PAYMENT


AMOUNT (SINGLE 

PAYMENT ONLY)€

TOTAL 

$1 - $29,


$30 00 - $49 

$50 00 - $99 

$100 00 - $499 

$500,00 and above 

(continued) 

NUMBER OF MATCHES€

962 

434 

506 

870 

129 

023 

PERCENTAGE OF SINGLE€

PAYMENT MAPRACfICE


RECORD MATCHES€

100. 

37. 

16. 

30. 

NOTE: Mean = $132 358; Median = $50 00; Mode = $100 

An additional 1 559 matches involved malpractice payments that belonged to a series of 

payments of unknown total value. 

DATA SOURCE: National Practitioner Data Bank. ANALYSIS: HHS Offce of Inspector General 

C - 2 
APPENDIX D€

ADVERSE ACTION RECORDS INVOLVED IN MATCHES 

SEPTEMBER 1, 1990 - MACH 19, 1992 

TYE OF ADVERSE NUMBER OF MATCHES PERCENTAGE OF PERCENTAGE ACTON 

TOTAL MATCHES 

TOTAL ADVERSE 

ACTON MATCHES€

Licensure 

Revocation 

Probation 

Suspension 

Miscellaneous 

Clinical Privileges€

Revocation 

Suspension 

Voluntary Su"ender 

Reduction in Prvileges 

Other Restrction€

Deninl


Revision to Action


Professional Society€

Membership 

Revocation


Suspension


Denial


Not Properly Coded


ADVERSE ACfrON OF ALL 

MATCHES MATCHES 

954 100. 

2,433 100, 11.6 

256 51.6 

560 

129 

515 

1I44 47. 5.5 

144 

164 

222 

122 

113 

292 

1.4 

D - 1 
ADVERSE ACfION RECORDS INVOLVED IN MATCHES 

SEP1EMBER 1, 199 - MACH 19, 199 

(continued) 

REASON FOR€

ACfION€

TOTAL MATCHES €

TOTAL ADVERSE 


ACION MATCHES


Alcohol and Other€

Substance Abuse 

Incompetence/Mal-€

practice/Negligence€

Narcotics Violations€

Felony€

Fraud€

NUMBER OF MATCHES€ PERCENTAGE OF PERCENTAGE 

ADVERSE ACfION OF ALL 

MATCHES MATCHE 

954 100. 

2,433 100. 11.6 

238€

380 15. 1.8€

0.4€

1.2€

10. 1.3€

0.5€

24.4€

24.€

1.4€

Unprofessional Conduct€

Mental Disorder€

Allowing Unlicensed€

Person to Practice 

Disciplinaty Action 

Taken in Another State€

Physical Impairment€

Other Reason--NOI€

Classified€

Miscellaneous Actions€

Not Properly Coded€

General Code Used€

263€

127€

594€

603€

DATA SOURCE: National Practitioner Data Bank. ANALYSIS: HHS Offce of Inspector General€

Reporters use this code when none of the aboe categories apply.€

Misellaneous licensure actions are not asigned clasification codes to parallel other ty of actions. The 

breakdow of misllaneous licensure action matches is as follow: License RestOred or Reinstated, 82 matches;

Reinstatement Denied, 5; Reprimand, 176; Other (Including Censure and Surrender), 249; License Denied (Renewal 

Only), 1 and Not Properly Coded , 2. In addition, there were 87 matches related to revisions to actions on hospital 

clinical privleges and 1 related to a revision to action on profesional soiety membership.€

D - 2€
APPENDIX E 

NOTES 

Health Care Quality Improvement Act of 1986 (P.L. 99-660), Section 402. 

Adverse actions include licensure revocation, suspension, and probation; clinical 

privilege revocation, suspension, reduction, restriction, and voluntary surrender; 

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

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

practitioners, such as license reinstatement. 

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

physicians and dentists, whereas other entities must report actions against 

physicians and dentists and may report actions against other licensed health 

care practitioners. 

Malpractice insurers do not submit reports of payments on behalf of facilties 

or corporations. 

Health care entities must provide health care servces and engage in 

professional review activity through a formal peer review process. 

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

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

proceedings. 

Presentation by Unisys project director at the National Practitioner Data Bank 

Executive Committee Meeting, Alexandria, VA, December 5, 1991. 

An exact figure is not available. The match count of 9 261 reported as of 

November 22, 1991, includes match types that do not fit the criteria used for 

this report. For example, it includes matches resulting from duplicate reports 

and queries. 

Some tyes of matches were excluded from the computer file. These were selfqueries, in which practitioners requested their own Data Bank records, and matches on reports that were later voided (i. removed from the Data Bank 

because of errors). 

The file we received from Unisys contained individual records for queries and 

reports. Included in each record was a field for "Practitioner Identification 

Number (PIN)." To construct our fie of matches, we created a new data set 

containing a single record for each request-report pair that named the same 

PIN. 

E - 1 
We made two assumptions regarding the file received from Unisys. The first 

was that the PIN in each record was correct, meaning that only queries and 

reports referring to the same individual were paired. The second is that, with 

the exceptions noted above, the file did in fact contain the entire set of 

practitioners for whom both a report and a query had been received. 

SAS Institute, Cary, NC, 1988. 

10. Unisys also excluded reports sent to practitioners queryng about themselves€

from the data base we received, but we do not know how many times this 

occurred. As of January 1992, the number of self-queries was 117. We 

estimate that there were between 125 and 200 self-queries excluded from the 

data base. 

The originaJ data set obtained from Unisys consisted of 23 153 matches, not 

counting matches on reports later deleted from the Data Bank. Of these, 260€

were echoes, 1 756 were from duplicate queries, and 183 were from duplicate 

reports. Therefore, 20 954 (90.5 percent) of the 23 153 original matches met 

our criteria for inclusion in the analysis. 

12. Cumulative Data Bank Statistics Summary, presented by Unisys project director 

at December 5, 1991, National Practitioner Data Bank Executive Committee 

Meeting, Alexandria, VA. 

13. Partial matches are cases when more than one, but not all identifyng fields 

match. 

14. Conversation with HRSA project officer, March 26, 1992.€

15. The number of matches is greater than the number of practitioners because€

practitioners could have been mentioned in more than one report or could have€

been queried about more than once.€

16. Our data on cumulative Data Bank reports and queries is drawn from the 

Cumulative Data Bank Statistics Summary, presented by Unisys project director 

at the December 5, 1991, National Practitioner Data Bank Executive 

Committee Meeting, Alexandria, VA. Because the primary purpose of our 

data request was to generate a sample of queriers who had experienced 

matches, we asked for the most recent data available rather than data available 

as of November 22, 1991. The analyses of reports and queries that were 

conducted on November 22, 1991, were not available for the period ending 

March 19, 1992. Our comparisons between the universe of matches and the 

universe of all reports and queries must be interpreted with this in mind. 

17. At the December 5, 1991 , Data Bank Executive Committee meeting, heads of 

national organizations of licensing boards mentioned several reasons for not 

queryng the Data Bank. These include cost, limited history in the Data Bank 

E - 2€
and duplication with the national organizations' own data bases. Certainly, as 

the Data Bank ages, it will have more complete historical information and wil 

likely be more attractive to the optional users. 

18. The remaining 0.2 percent of hospital matches were from queries marked as 

state licensing board (4 matches), or other (42 matches). This indicates that 

some hospitals may not be sure which of the "query tye" boxes on the query 

form they should check, or that some non-hospitals were inappropriately 

assigned identification numbers in the hospital category. 

19. The number of matches is greater than the number of reports because multiple 

queriers can match on the same report. 

20. See note 16 above. 

21. These calculations are based only on the 16 962 matches involving one-time 

payments. Excluded are 1 559 matches involving payments that were part of a 

series of installments, and for which the total payment amount was not 

available. 

22. There has been recent discussion of imposing a floor dollar amount on 

malpractice payment reports, which would eliminate reports for payments 

under the floor. The Physicians Insurance Association of America has 

recommended a floor of $50 000, while the American Medical Association has 

proposed a floor of $30 000 (Letter from the Chairman of the PIA Data 

Sharing Project to the Director of the Bureau of Health Professions, HRSA on 

February 25, 1991). A $30 000 floor would have eliminated 37.9 percent of the 

matches, and a $50 000 floor would have eliminated another 8.9 percent 

(appendix C). This subject is covered more fully in our report titled "National 

Practitioner Data Bank: Malpractice Reporting Requirements " OEI-01-90-

00521 , April 1992. 

23. One report mistakenly gave 1908 as the date of the incident. This report 

generated a match for seven different queries. 

24. See note 16 above. 

25. The coding system for classes of and reasons for adverse actions was taken 

from the National Practitioner Data Bank reporting instructions. 

26. A match was considered to be an interstate match if the querier s State was 

different from either the practitioner s work State or, for adverse actions, the 

reporter s State. We did not use the reporter s State for malpractice payment 

matches because many physicians are insured by out-of-State companies. 

E - 3€