� 

,, 

f 

Department of Health and Human Services I 

OFFICE OF 

INSPECTOR GENEW 

NATIONAL PRACTITIONER DATA BANK: 

PROFILE OF MATCHES UPDATE 

~~SERWc~$ 

& ‘C.. 

9 

v 

$ JUNE GIBBS BROWN
 ~


s

‘% $ Inspector General


‘%dyq AUGUST 1994 

%. 2

OEI-01-94-00031 

—- --——. 
OFFICE OF INSPE(TOR GENERAL 

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

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

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

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

inspections conducted by three OIG operating components: the Office of Audit Services, the 

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

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

correct them. 

OFFICE OF AUDIT SERVICES 

The OIGS Office of Audit Services (OAS) provides all auditing services for HHS, either by 

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

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

carrying out their respective responsibilities and are intended to provide independent 

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

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIGS Office of Investigations (01) conducts criminal, civil, and administrative 

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

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

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

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

OFFICE OF EVALUATION AND INSPECTIONS 

The OIG’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 in the Boston regionai 

office under the direction of Mark R. Yessian, Ph.D., Regional Inspector General, and Martha 

B. Kvaal, Deputy Regional Inspector GeneraL Project statl 

BOSlON HEADQUARTERS 

David Veroff, Project Leader Alan Levine, Program Specialist 

For additional copii.sof thisrepo~ pkase contact the Boston regionalo~e by telephone at 

(617) 56S-1050,or by f= at (617) 565-3751. 

. –-— .———— __ 
Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENER/uj 

NATIONAL PRACTITIONER DATA BANK: 

PROFILE OF MATCHES UPDATE 

. 

5 JUNE GIBBS BROWN ~ 

s

*v $ Inspector General 

% 

~+>%dy~ AUGUST 1994 +

2

OEI-01-94-00031 

—— —— 
EXECUTIVE SUMMARY


PURPOSE 

To update a profile of National Practitioner Data Bank matches--those occasions on 

which the Data Bank has provided reports of malpractice payments or adverse actions 

to requesting entities. 

BACKGROUND 

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

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

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

health care entities with information relating to the professional competence and 

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

receives reports of adverse actions against practitioners from State licensing boards, 

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

of malpractice payments from malpractice insurers. 

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

82623 reports of adverse actions or malpractice payments. When a request names a 

practitioner who has been reported to the Data Bank, the request-report pair is 

referred to as a “match.” As a result of the queries made by April 1994, 152,941 

matches had occurred. 

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

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

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

information about the Data Bank’s history that was not available elsewhere. The 

Administrator of the Health Resources and Services Administration recently asked for 

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

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

which is now underway. 

FINDINGS 

NUMBER OF WITCHES: By Februmy 1994, the ZotaInumber of matches was abnost 

7 ti huger than it was as of Mada 1992 

�	 The total number of matches increased from 20,954 as of March 1992 to 

144,649 as of February 1994. 

�	 The average number of matches per month increased from 1,126 in the period 

prior to March 20, 1992 to 5,022 in the later period. 

i 
TYPES OF PM CT17TONERS INKOLKED IN M=4TCHES: l%e majody of 

pmctitioners involved k matcha continue to be physiiimu. 

� In each period, 93 percent of the matches involved physicians. 

TYPES OF OVERIERS RECEIVIIVG M4TCH INFORMATION: JWtik mmt of the 

matches stiff rend @m quaies by hospita~ a much higher proportion of matches now 

rauil @m queriin by health rnabztenance orgatitiom and group practictx 

�	 On average, queriers receiving any match information matched on many more 

practitioners than they had in the earlier study period. 

TYPE OF REPORTS RESULTING IN M4TCHES: I& reports involved in matches are 

still hugely ma@actke payment reprts. 

� The size of the malpractice payments involved in matches has grown somewhat. 

�	 Licensing boards and hospitals each still account for about half of the adverse 

action reports involved in matches. 

lN?ERSTAT2Z MATCHES: A greater pqxxtzhn of matches suppij information about 

pmctitiimm who cnxed state likes 

�	 Interstate matches accounted for 9.3 percent of all matches in the earlier study 

period; in the later period, they accounted for 15.3 percent. 

CONCLUSION 

In the future, regardless of shifts in the volume of matches and types of queriers 

involved in matches, we can expect most matches to involve reports on physicians with 

malpractice payments. 

The growth in the number and proportion of matches resulting from queries from 

health maintenance organizations and group practices may indicate that volunta~ 

queriers are more aware of the Data Bank than they used to be and/or that they sense 

it is valuable to query the Data Bank. 

APPENDICES 

In four appendices, we provide details on the types of practitioners. queriers, 

malpractice payments, and adverse actions involved in matches. 

ii 

— 
TABLE OF CONTENTS


PAGE 

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


~OIXJCI’ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I


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


Number ofmatches . . . . . . . . . . . . . . . . . .
. . . . . . ,,...O . . . . . . . . . . . . . . . 3


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


. . . . . . 4


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


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


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


Interstate matches . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . ..O . . . . . . . 6


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


APPENDICES 

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


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


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


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


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


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


ENotes . . . . . . . . . . . . . ..OOO
. . . . . . . . . . . . . . . . . . . . . . ..O . . . . . . . . . . E-1

INTRODUCTION


PURPOSE 

To update a profile of National Practitioner Data Bank matches--those occasions on 

which the Data Bank has provided reports of malpractice payments or adverse actions 

to requesting entities. 

BACKGROUND 

The National Practitioner Data Bank maintains records of malpractice judgments and 

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

Title IV of the Health Care Quality Improvement Act of 1986 (P.L. 99-660) and has 

been in operation since September 1, 1990. The Data Bank is fimded by user fees 

and is administered by Unisys Corporation under contract to the Health Resources 

and Semites Administration (HRSA) of the Public Health Service (PHS). 

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

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

health care practitioners. Congress believed the Data Bank could, among other things, 

help “restrict the ability of incompetent physicians to move from State to State without 

disclosure or discovexy of the physician’s previous damaging or incompetent 

performance.”1 

II DEFINITION OF TERMS USED IN THIS REPORT 

REPORT Information sent to the Data Bank about a 

* practitioner by a malpractice insurer, hospital, 

n licensing board, or professional society. 

RECORD A report that has been received and is 

permanently stored by the Data Bank. 

H 

QUERY � m

A request for information about a practitioner 

submitted to the Data Bank by a hospital, 

licensing board, or other health care entity. 

MATCH z A pairing of a record and quexy that identifies 

H‘m 

the same practitioner. 

1

State licensing boards, hospitals and other health care entities, and professional


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


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


care entities and professional societies may report certain actions against other


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


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


practitioners.4


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


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


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


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


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


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


for all practitioners with privileges.b


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


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


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


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


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


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


matches.’


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


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


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


information about the Data Bank’s history that was not available elsewhere. The


Administrator of the Health Resources and Services Administration recently asked for


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


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


which is now undenvay.


METHODOIQGY


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


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


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


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


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


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


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


Quality Standards for Inspections issued by the President’s Council on Integrity and


Efficiency.


2

FINDINGS


NUMBER OF WITCHES: By February 1994, the total number of matches was aikumt 

7ti LIIgerthan it was as of Mad 1992 

Between September 1, 1990, and March 19, 1992 (Period A), a total of 20,954 matches 

occurred. Between March 20, 1992 and February 25, 1994 (Period B), 123,695 

matches occurred. The total number of matches horn September 1, 1990 to February 

25, 1994 was therefore 144,649 or 6.9 times larger than the 20,954 matches as of 

March 19, 1992.11 Figure 1 below describes the increase in the average number of 

matches per month between the two periods. The increase in matches is driven by 

two forces: a rise in the number of queries and a larger volume of records in the 

Data Bank available to be matched against. The total number of queries grew from 

about 1 million after the end of Period A to over 3 million after the end of Period 

B.12 The total number of records available to match against grew from about 25,000 

at the end of Period A to over 75,000 at the end of Period B.13 The approximate 

odds of a query resulting in a match jumped from 1 in 50 over Period A to 1 in 17 

over Period B.14 With this increase in the “match rate” and the increase in queries, 

the large increase in matches is not surprising. 

Figure 1 

THE AVERAGE NUMBER OF MATCHES PER MONTH HAS GROWN DRAMATICALLY 

FROM PERIOD A (9/90 - 3/92) TO PERIOD B (3/92 - 2/94) 

Matches/Month 

6000, 

5500 J 

I 

I 

4500-

4000-

3500-

3000-

2500-

2000-

I 

I 

1000 

500 L 

Period A Period B MTA SOU17ClS N@md Fnd9mur WmANALW!SH US06hd~Qunrd 

3


—__ 
~eamount ofifiomation from each matching que~has increased slightly. In 

Period B, 102,120 queries matched 123,695 records. This means that each query 

involved in a match provided the querier with an average of 1.21 (123,695 + 102,120) 

records per query in Period B. This is 10.0 percent more information than the 1.1 

records per query in Period A (19,034 queries matched 20,954 records). 

TYPES OF PM C777YONERS INVOLVED IN MA TCHE$: 2%?mujority of practitioner 

involved in matches contihue to be physicims 

There were 32,605 different practitioners represented in matches that occurred in 

Period B; this compares with the 10,185 represented in matches in the earlier 

period. 15 In both periods, 93 percent of the matches involved physicians. In Period 

~ 4 percent involved dentists; 3 percent involved dentists in Period B. Appendix A 

displays the types of practitioners involved in matches. 

Seventy-six percent of all reports to the Data Bank as of April 30, 1994 involved 

physicians,lb whereas 93 percent of the matches from March 20, 1992 through 

February 25, 1994 involved physicians. This disparity is not surprising because 

hospitals are the only mandated queriers of the Data Bank and are most likely to 

query about physicians. 

TXPES OF (9UERIERS RECEIJ?ZNGikMTCH INFOIWIX770N: While most of the 

matches still rtxiultjhm queries by Jz.apiM& a much higher proportion of mutches now 

result fmm qutvies by health nuuktenunce oqanizaticms and group pmcn”ceis 

The number of queriers who submitted requests that led to matches increased from 

4,357 in Period A to 6,954 since then.1’ Of these matching queriers, a much smaller 

proportion were hospitals in the more recent period (72.3 percent compared to 

91.3 percent). A much greater proportion were health maintenance organizations 

(HMOS) and group practices (24.2 percent compared to 6.5 percent). Figure 2 

displays these figures graphically appendix B provides details. 

While hospitals are the only organizations required by law to query the Data Bank, 

standards put in place in 1993 require HMOS interested in receiving National 

Committee for Quality Assurance accreditation to query the Data Bank for each 

practitioner seeking credentials or renewing credentials.ls This may explain part of 

the large increase. 

Most of the 89,430 hospital matches in Period B resulted from mandato~ two-year 

queries (66.1 percent). Initial privileging and employment queries accounted for 

32.0 percent and professional retiew activity accounted for 1.4 percent.19 These 

proportions are very similar to those in the earlier period. 

4

Figure 2 

A MUCH HIGHER PROPORTION OF MATCHES NOW RESULT FROM QUERIES 

BY HMOS AND GROUP PRACTICES I 

Matchesby Type ofQuerfer Matches ByType of Quener 

PeriodA (9/90 +/92) PerfodB (3/92 - 2/94) 

N-20,954 N=123,695 

- (7294) 

) Other(4%) 

(7%) 

HMO/GP(24%) 

I

MTASOURCi2NMknd Rmdlanr OdskA NIAAYSSHHSOMmdh@omr Qana@ 

�	 On average, queriers receiving any match information matched on many more 

practitioners than they had in the earlier study period. 

Querierswho match are submitting queries and matching on more than one 

practitioner. Up until March 1992, the mean was 4.4 practitioners matched per 

querier; since March 1992. that figure has grown to 14.7 practitioners matched per 

querier. While this is clearly a function of more information being available in the 

Data Bank, it is a remarkable growth nonetheless and may give matching queriers a 

better understanding of the full range of information available in the Data Bank. 

Fourteen percent of queriers in the second study period matched on exactly 1 

practitioner, and 46 percent matched on 5 or fewer. A few queriers matched on many 

more practitioners; 1 national health maintenance organization matched on 3,390 

different practitioners in Period B. 

TYPE OF REPOR7S RESUL77NG IN MTCHES: % reports involved in matcti are 

still Iatgely malpractice payment reprts 

Since March 1992, a total of 1,971 reporters have submitted 40,355 adverse action or 

malpractice reports that have been matched.20 While these numbers have increased 

significantly since our first study period, the proportions of the total involving 

malpractice payment reports versus adverse action reports has not shifted much. In 

Period ~ malpractice payment reports made up 88 percent of all the matches; 

5

adverse actions made up 12 percent; in Period B, those figures were 89 percent and 

11 percent respectively. 

� The size of the malpractice payments involved in matches has grown somewhat. 

From September 1, 1990 to March 19, 1994 the malpractice payment amounts 

involved in matches ranged from $1 to $4,675,000, with a mean of $132,358.21 Both 

the range and the mean have grown since then. The range in the period since March 

1992 now extends to $9,000,000 and the mean is $199,114. The median has also 

grown,from $50,000 to $60,000.Z Appendix C displays these figures in tabular form. 

The distribution of matches into categories of acts or omissions has remained 

essentially the same. In both periods, a majority of the malpractice reports that 

appeared in matches fell into three major types of acts or omissions: 32 percent were 

surge~-related, 28 percent diagnosis-related, and 19 percent treatment-related. 

Appendix C summarizes the types of acts or omissions. 

�	 Licensing boards and hospitals each still account for about half of the adverse 

action reports involved in matches. 

Adverse action reports appearing in matches came from two major sources. In the


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


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


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


each period came from professional societies reporting about membership actions.


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


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


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


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


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


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


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


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


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


INTERSTATE M4TCHES: A greater proportion of matcher supply information aboti 

praditionm who crossed state lhws. 

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


and unprofessional practitioners from evading detection by simply crossing State lines


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


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


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


evidence of incompetence or unprofessionalism. We cannot determine whether these


matches have actually protected the public from potential harm.


6 
CONCLUSION


Thenumber ofmatches hasgreatly increased since March 1992 anda much larger 

proportion ofmatches nowresultfiom queries from heakh maintenance organizations 

and group practices. Despite these shifts, the vast majority of matches continue to 

involve physicians andtoconcem malpractice payments. This indicates that in the 

future, regardless of shifts in the volume of matches and types of queriers involved in 

matches, we can expect most matches to involve reports on physicians with 

malpractice payments. 

The growth in the number and proportion of matches resulting from queries from 

health maintenance organizations (HMOS) and group practices may indicate that 

voluntary queriers are more aware of the Data Bank than they used to be and/or that 

they sense it is valuable to query the Data Bank. We will examine questions of 

usefulness and impact of Data Bank information, including to HMOS and group 

practices, in upcoming reports. 

7

APPENDIX A


NATIONAL PRACHT’IONER DATA BANK PROFILE OF MATCHES 

PRACHTIONERS INVOLVED IN MATCHES 

TYPE OF PRACITf’IO~ER NUMBER OF NUMBER OF 

MATCHES MATCHES 

Period k 9/lPO - 3J19J92 Pericd B: 31’20f92- 2/25J94 

TOTAL 20,954 123,695 

Physicians and Dentists 20,165 (%.2%) 119,501 (%.6%) 

Allopathic Physicians 18,038 ~ 10~198 

Allopothic Physician Residents 219 1,298 

Osteopathic Physicti 1,135 6978 

Osteopathic Physieion interns and Residents 26 ~ 132 

Dentists


Dento/ Residents


Podiatrists 

Psychologists 

Other Health Care Disciplines/Personnel 

chiropractors 

Dentwirts 

MentolHeolth Coumelors 

Opticions 

Optomo’i.m 

Pharlnacirk3 

Physicbt Assistants 

Physician Assistontr, Osteopath 

Podiotric Assistants 

professional Counselors 

735 1 3,856 

12 ~ 39 

486 (2.3%) I 2,582 (21%) 

51 (0.2%) ~ 248 (0.2%) 

36 (0.2%) I 188 (0.2%) 

x 82 

01 2 

o 2 

o 10 

20	 .x’ 

0; 2 

51 32 

0’ I 

2, 0 

16 30 

Professwnal Counselom Fm”t’ylMmiage 2 4 

Nurses and Related 30 (0.1%)I 192 (0.2%) 

Registered (Professwnai) Nurses


Nurse Anesthetists


Nurse Mkiwives


Nurse Practitioners


Psychiatric Technicians


Emergency Care Personnel 

kxial Workers 

rehabilitation/Restorative Services Personnel 

technicians and Technologists 

4’ 15 

24 139 

1 29 

0: 2’ 

I, 7 

2 (0.0%), 18 (0.0%) 

o (0.0%) ~ 4 (0.0%) 

4 (0.0%) f 20 (0.0%) 

2 (0.0%) ; 18 (0.0%) 

fot Properly Coded 178 (0.8%) I 924 (0.7%) 

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

A-1


— .—— 
APPENDIX B


NATIONAL PRACTITIONER DATA BANK PROFILE OF MATCHES 

QUERIERS INVOLVED IN MATCHES 

TYPE OF QUERfER 

TOTAL 

Non-Federai Hoapitai 

1. p“vikgingkrnpioyrnuu 

Mandatay rwo-year review 

Rof~ review ocnvily 

Oltw 

Siatc Ucaauhg Boar~_ 

HMCmPo 

Inidol priV&?g@ltmp@wu?u


Mandamy IW-ycor review


Bofmionol reviewOctiviiy


Otk


Statetiming Boord~


Other Non-Fedemi Health Care Entity 

Irri&d fWiVik@l@.??lf)@ftlUU 

Mn&lOty lrvo-ycorreview 

Rof~ reviewOctiviy

other 

State Lictnsing Boord~ 

Federal Hospital 

Inidd privilegingkrrlpbyrnent 

Man4UOIY IWO-yaw revkw 

Profarional review octivy 

other 

State LicensingBoard 

State liceming boord 

Mondumy two-year mv&/ 

hidOlpnvile@glmplo&_ 

Profmionol review 

Group Practice 

II ProfesaionaiSociety 

1Other Federal Health Care Entity 

!~’Not Properly Coded 

I 

I 

I 

! 

I 

1 

1 

NUMBER OF MATCHES NUMBER OF WTCHES 

Period k 9ni90 - 3f19B2 1 Period B: 31ZO192-225194 1 

20,954 123,695 

18,788(89.7%) 87,434 (70.7%) 

6278 2~523 

12J64 54274 

301 1,257 

42 2s1 

3 129 

1319 (6.3%) 25,046 (20.2%) 

776 15,234 

158 4736 

350 4548 

35 42s 

o	 83 I I 

382 (1.8%) %711 (22%) 

257 1,693 

111 845 

12 130 

1 43 

1 0 

3M (1.6%) 1,9% (1.6%) 

202 1,144 

127 8.28 

5 23 

o 1 

69 (0.3%) 800 (0.6%) i 

65 766 

3 15 

I 17 

o 2 

42 (0.2%) 4,970 (4.0%) 

, 

15 (0.1%) I 478 (0.4%) // ( I 

5 (0.0%) 258 (0.2%) 

o (0.0%) 2 (0.0%) 

DATA SOURCE National Practitioner Data Bank. AIIALYSIS: HHS Office of Inspector General 

‘Denotes inconsistency between querying entny type and query type; could result from improper form completion 

or incorrect assignment of entity type code. 

B-1 
APPENDIX C


NATIONAL PRACTITIONER DATA BANK PROFILE OF MATCHES 

MALPRACTICE PAYMENT REPORTS INVOLVED IN MATCHES 

TYPE OF 

ACT/OMISSIONz 

TOTAL 

MALPRMXICE 

PAYMENT 

MATCHES 

Surge~-Related 

Diagnosis-Related 

Treatment-Related 

Medieation-Related 

Obstetrics-Related 

Anesthesia-Related 

Monitoring-Related 

NUMBER OF NUMBEROF 

MALPRACTICE MATCHES MALPRACTICE MATCHES 

Period k 9/MJO- 3/19/92 Period B: 31’20P2- 2f25P4 

Total Matches = 20,954 Total Afatches=123,695 

110,058 

34,949 (31.8%) 

30,723 (27.9%) 

21,055 (19.1%) 

7,024 (6.4%) 

8,871 (8.1%) 

3,067 (2.8%) 

1377 (1.3%) 

796 (0.7%) 

1,271 (1.2%) 

533 (0.5%) 

392 (0.4%) 

18$21 

5,871 (31.7%) 

5,125 (27.7%) 

3,440 (18.6%) 

1s35 (7.2%) 

l@5 (6.9%) 

583 (3.1%) 

235 (1.3%) 

220 (1.2%) 

206 (1.1%) 

121 (0.7%) 

99 (0.5%) 

I


Intravenous and Blood 

Products-Related 

Miscellaneous 

Biomedical Equipment/ 

Product-Related 

Not Properly Coded 

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

lMalpractice payment reports can be given one or two codes indicating type of act or omission. Of the 18,521 

maipractim payment matches in the first period, only 4,088 were assigned two codq in the second period, only 

21,286 had two codes. For clarity, these secondary codes have been disregarded in this table. 

c-1 

—. 
NATIONALPRACIT170NERDATA BANK PROFILE OF MATCHES 

MALPRAC’lTCE PAYMENT REPORTS INVOLVED 

WRACTICE PAYMENT 

AMOUNT (SINGLE 

PAYMENTS ONLY) 

TOTAL WRACTICE 

PAYMENT MATCHES 

$1- $29,!399 

$30,000-$49,999 

$50,000-$99,999 

$100,000-$499,999 

$500,000 and above 

IIMean 

Median 

Mode 

(continued) 

NUMBER OF MATCHES 

Period k 9/1/’90- 3/19/92 

16,962 

6,434 (37.9%) 

1#36 (8.9%) 

2870 (16.9%) 

5,129 (30.2%) 

1,023 (6.0%) 

$132,358 

$50,000 

$1OO,OOO 

IN MATCHES 

NUMBER OF MATCHES 

Period B: 3f20P2 - 2/2SP4 

101,492 

36,268 (35.7%) 

8,739 (8.6%) 

16S50 (16.3%) 

32,560 (32.1%) 

7375 (7.3%) 

$149,114 

$60,000 

$200,000 

NOTE: An additional 1S59 matches in Period A and 8,566 in Period B involved malpractice 

payments that belonged to a series of payments of unknown total value. 

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

c-2 

—. 
APPENDIX D


NATIONAL PRACTITIONER DATA BANK PROFILE OF MATCHES 

ADVERSE ACIION REPORTS INVOLVED IN MATCHES 

TYPE OF ADVERSE NUMBER OF ADVERSE NUMBER OF ADVERSE 

ACTION ACTION MATCHES AC1’’IONMATCHES 

Period k 9/1/90 - 3119P2 Period B: 3/20/92 - 2/25/94 

Total Matches = 20,954 Total Matches= 123,695 

TOTAL ADVERSE &433 13,637 

ACTION MATCHES 

Lieensure I 1*6 (51.6%) 7,567 (55.5%) 

Revocation 

Probation 

Suspension 

Miscellaneous 

Clinical Privileges 

Revocation 

Suspension 

Voluntcuy Surrender 

52 288 

560 3,020 

129 912 

515 3,347 

1,144 (47.0%) 5,905 (43.3%) 

144 809 

164 1,124 

222 1,067 

122 621 

113 617 

292 1,206 

Reduced Privileges 

Other Restriction 

Denial 

Revision to Action 

Professional Society 

Membership 

Revocation


Suspension


Denial


Other Restriction


Not proper~ Coded


, 87 461 

33 (1.4%) 165 (1.2%) 

7 67 

8 17 

17 52 

o 11 

1 18 

D-1 

-- —.. _ 
ADVERSE ACTION REPORTS INVOLVED IN MATCHES


REASON FOR 

ACTION 

TOTAL ADVERSE 

ACTION MATCHES 

Alcohol and Other 

Substance Abuse 

Ineompetenee/MaIpractice/Negligence 

Narcotiea Violations 

Felony 

Fraud 

Unprofessional Clmduct 

Mental Disorder 

Allowing Unlicensed 

Person to Practice 

DisciplinaryAction 

I’aken in Another State 

PhysicalImpairment 

Other Reason--Not 

21assifled1 

Uiseellanems Actions2 

Yot Properly Coded, 

3eneral Code Used 

(continued) 

NUMBER OF ADVERSE 

AC170N MATCHES 

Period A: 9/1190- 3119L32 

TotaI Matches = 20,954 

2,433 

238 (9.8%) 

380 (15.6%) 

93 (3.8%) 

28 (1.2%) 

27 (1.1%) 

263 (10.8%) 

14 (0.6%) 

21 (0.9%) 

127 (5.2%) 

11 (0.5%) 

594 (24.4%) 

603 (24.8%) 

34 (1.4%) 

NUMBER OF ADVERSE 

ACT’IONMATCHES 

Period B: 3t20i92 - 2J’2W4 

Total Matches =123,695 

13,637 

1300 (9.5%) 

1,988 (14.6%) 

470 (3.4%) 

149 (1.1%) 

161 (1.2%) 

1,295 (9.5%) 

97 (0.7%) 

95 (0.7%) 

700 (5.1%) 

51 (0.4%) 

3,320 (24.3%) 

3,826 (28.1%) 

185 (1.4%) 

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

lReporters use this code when none of the above categories appty. 

2Misce11aneous Iicensure actions are not assigned clasifieation codes to parallel other types of actions. The 

breakdown of miscellaneous licensure action matchea is as follows (Period A followed by Pe~iod B): License Restored 

or Reinstated, (Period A) 82 and (Pericd B) 604; Reinstatement Denied, 5 and 41; Reprimand, 176 and 9W, Other 

(Including Censure and Surrender), 249 and 1,734 License Denied (Renewal Only), 1 and 10, and Not Properly 

Coded, 2 and 12 In addition, there were 87 matches in Period A and 461 in Period B related to revisions to actions 

on hospital clinical privileges and 1 in the Period A and 18 in Period B related to a revision to action on professional 

society membership. 

D-2 
APPENDIX E


1. 

2. 

3. 

4. 

5. 

6. 

7. 

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 surrende~


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


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


practitioners, such as license reinstatement.


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


physicians and dentists, whereas other entities must report actions against


physicians and dentists and may report actions against other licensed health


care practitioners.


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


disciplinary actions on physicians and dentists based on reasons related to


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


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


professional competence or conduct adversely affecting clinical privileges for a


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


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


professional review actions based on reasons related to professional


competence or conduct adversely affecting membership.


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


or corporations.


Health care entities must provide health care services 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.


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


Resources and Semites Administration, Bureau of Health Professions, Division


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


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


(presented in our findings) is somewhat different than HRSA’S; in particular,


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


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

E-1

8.	 The initial profile report was entitled National Practitioner Data Bank Profile of 

Mulches (Department of Health and Human Services, Office of Inspector 

General, National Practitioner Data Bank Profile of Matches, OEI-01-90-(X)522, 

April 1992). The broad study of usefulness and impact produced two reports: 

Department of Health and Human Services, Office of Inspector General, 

National Practitioner Data Bank Usefi[ness and Impact of Repotis to Hospitah, 

0EI-01-90-O0520, February 1993 and Department of Health and Human 

Services, Office of Inspector General, National Practitioner Data Bank 

Use&lness and Impact of Repons to State Licensing Boariir, OEI-01-90-00523, 

March 1993. 

9.	 Because of the time our analysis and reporting of the data we requested for our 

study of the usefulness and impact of matches took, we were able to get 

cumulative statistics on Data Bank activity that was more recent than February 

1994. At several points in this report, we reference data on the universe of all 

reports and queries as of April 30, 1994. While we cannot make date-speciilc 

comparisons between the universe of matches and the universe of all reports 

and queries, it is highly unlikely that even if we had information for exactly the 

same dates our comparisons would be markedly different given historical trends 

for this information,. 

10.	 Some types of matches were excluded from the computer file. These were selfqueries, in which practitioners requested their own Data Bank records, and 

matches on reports that were later voided (i.e., removed from the Data Bank 

because of errors). 

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

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

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

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

PIN. 

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

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

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

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

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

11.	 In addition, there were a number of “echoes” (in which a querier receives 

information it had previously submitted), duplicate reports, and duplicate 

queries. None of these (28,650 matches in the more recent period) constituted 

a real transfer of information, and thus they are not included in any of our 

other summary statistics. Unisys also excluded reports sent to practitioners 

querying about themselves from the data base we received, but we do not know 

how many times this occurred. 

E-2

12. 

13. 

14. 

15. 

16. 

17. 

18. 

19. 

20. 

21. 

Numbers are approximate since the information we have on queries is from 

slightly different time periods than our study periods. 

Numbers of reports are approximations because the information we have 

available is from somewhat different time periods than the study periods. 

The odds of matching continue to grow. Queries received in the month of 

February 1994 had a better than 1 in 14 chance of matching, according to 

HRSA communication. 

The number of matches is greater than the number of practitioners because 

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

been queried about more than once. 

The total number of practitioners involved in matches is probably smaller than 

the number in the first period added to the number in the second period 

because practitioners matched on in the first period could well have been 

matched on in the second period as well. According to Data Bank records, as 

of ApriJ 30, 1994, 37,554 practitioners had been matched on; this is smaller 

than the sum of 32,605 and 10,185 even though it is for a longer time period 

and includes practitioners matched on by self-queries. 

Department of Health and Human Services, Public Health Sexvice, Health 

Resources and Services Administration, Bureau of Health Professions, Division 

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

Month Ending April 30, 1994, Internal Document. 

This does not mean that the total number (from September 1, 1990 to 

February 1994) of queriers who submitted requests resulting in matches was 

over 11,000. Many who matched in the first period probably matched in the 

second period. 

National Committee for Quality Assurance, Accreditation Standards, 

Credentialing Standards 7.1 and 11.1 (1993) 2S, 30. 

The remaining 0.5 percent of hospital matches in the later period were from 

queries marked as State licensing board (129 matches), or other (251 matches). 

This indicates that some hospitals may not be sure which of the “query type” 

boxes on the query form they should check, or that some non-hospitals were 

inappropriately assigned identification numbers in the hospital category. 

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

queriers can match on the same report. 

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

uavments. Excluded are 1.559 matches invokhw uavments that were Dart of a 

E-3

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

available. 

22.	 These calculations are based only on the 16,962 matches in Period A and 

101,492 matches in Period B involving one-time payments. Excluded are 1,559 

matches in Period A and 8,566 in Period B involving payments that were part 

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

available. 

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

from the National Practitioner Data Bank reporting instructions. 

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

different ffom 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-4