Report Identifies Problems With National Database of Physician Misdeeds

Some reports of physician misbehavior may not show up in searches of a national database used by hospitals and others making decisions about hiring or disciplinary actions. Image to come: Ivan Ivanov/

Some reports of physician misbehavior may not show up in searches of a national database used by hospitals and others making decisions about hiring or disciplinary actions. Image: Ivan Ivanov/

A national database that helps hospitals and state medical boards identify physicians who have had a history of disciplinary actions and malpractice payouts may have flaws that let some reports go unnoticed, according to a report by Public Citizen, a civic watchdog organization.

By law, the National Practitioner Data Bank (NPDB), which is maintained by the Health Resources and Services Administration, collects information on all medical liability settlements, medical license revocations, and disciplinary actions against physicians by state medical boards, hospitals, and professional societies. Hospitals, state medical boards, and other health care organizations consult the NPDB for information on physicians that may be relevant in hiring decisions or disciplinary actions. But users may get incomplete information when they query the database, the report found.

Specifically, reports submitted to the database by the Department of Health and Human Services’ Office of Inspector General (OIG) that have information that the OIG has prohibited a physician from participating in federal health programs may have errors that cause the reports to slip by unnoticed, according to Public Citizen. Such holes in the data could lead to serious repercussions for hospitals, which may fined if they employ or contract with an clinician who has been excluded from providing services to Medicare or Medicaid patients. According to the report, an analysis by NPDB staff found that only 47% of the 8845 OIG reports submitted to the database from 1990 through 2012 had been disclosed to users of the database, compared with 71% of reports from medical boards and 85% of reports from hospitals. Public Citizen found errors in OIG exclusion reports, such as incorrect information about which state had licensed the physician or a lack of identifying information.

The OIG in May recommended that hospitals and other users of the NPDB directly search OIG’s exclusion database. The Centers for Medicare & Medicaid Services maintains its own Medicare Exclusion Database, in part because of previous difficulties with the OIG reports. But Public Citizen argues that OIG should improve its reports to the NPDB so that users don’t have to consult multiple databases.

“Making OIG exclusion reports more accessible to users of the NPDB would improve patient safety and program integrity in the health care industry by ensuring that the serious provider problems that caused the exclusion in the first place are known to potential employers such as hospitals or HMOs and to medical boards when they do background checks on these individuals,” said Sidney M. Wolfe, MD, director of Public Citizen’s Health Research Group, in a statement.

The OIG will begin using National Provider Identification Numbers to help improve the usability of its reports, a step that has been recommended by Public Citizen. But the OIG will provide the numbers only for reports made after 2009, which according to Public Citizen represents about 16% of the total exclusion reports.

Categories: Health Policy, Law and Medicine, Medical Ethics