Elizabeth Lowery, MPH U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce Division of Practitioner Data Bank National Credentialing Forum February 11-12, 2016

Overview National Practitioner Data Bank (NPDB) general provisions Updates Updated NPDB Guidebook System enhancements Education opportunities New compliance efforts Resources Contact information 2

General Provisions Medical malpractice judgments, settlements Adverse licensing and certification actions Clinical privileges actions Health plan contract terminations Professional society membership actions Negative actions/findings from private accreditation organizations and peer review organizations Government administrative actions, e.g., exclusions from programs Civil and criminal health care-related judgments Types of Information Collected 3

General Provisions Reporting (no charge) Querying (by hospitals and health care organizations) $3 for a one-year continuous query subscription $3 for a one-time query Fees lowered October 1, 2014 Self-Query (by an individual or organization) $5 Fee lowered October 1, 2014 Types of Transactions 4

General Provisions Immunity provisions in Title IV, Section 1921 and Section 1128E protect individuals, entities, and their authorized agents from being held liable in civil actions for reports made to the NPDB unless they have actual knowledge that the information in the report is false Health care entity professional review bodies, their members, and their agents are immune from civil liability in most cases Civil Liability Protection 5

Guidebook 6

Guidebook Overview Revised a policy manual last updated in 2001 Released draft NPDB Guidebook for comment in November, 2013 Received 360 comments Final version released April 6, 2015 Available formats: Printable and searchable PDF Web-based version with search capabilities Revision Process 7

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Guidebook Key Changes Blends Healthcare Integrity and Protection Data Bank and NPDB to reflect new combined regulations Adds Section 1921 Provides policy clarification What the new Guidebook does 10 What the new Guidebook does NOT do Make revisions that require legislative or regulatory changes Accept or address every recommendation made by commenters

Key Changes Definition of “Other Health Care Entity” Registration requirements (use of DBIDs, User IDs) 11 Eligible Entities Subjects of Reports Definitions of health care practitioners, providers, and suppliers

Key Changes Centralized vs. decentralized credentialing Delegated credentialing vs. using an agent Clinical vs. non-clinical privileges 12 Queries Reports Submitting reports Corrections vs. revisions Appeals

Key Changes Oral vs. written claims Identifying practitioners 13 Reporting Medical Malpractice Payments Reporting Adverse Clinical Privileges Actions Summary Suspensions Proctors

Key Changes Definition of term is not controlled by entity’s bylaws Routine review of a practitioner is not an investigation Focus must be on a particular practitioner Precursor to professional review action Ongoing until decisionmaking authority takes final action Investigations 14

Key Changes Expert witness testimony 15 Reporting Adverse Professional Society Membership Actions Reporting Other Adjudicated Actions Taken in conjunction with clinical privileges actions

Key Changes Administrative fines Summary/emergency suspensions Stayed actions Denials Withdrawals and failure to renew while under investigation Voluntary surrenders Reporting Licensure and Certification Actions 16

System Enhancements

Enhancements Easier-to-navigate home page Launched June 1, 2015 New look and feel Content organized in three main categories: For Health Care Professionals For Organizations NPDB Resources Reaction so far: positive Website 18

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Enhancements Adding carousel of photos to home page Each entity type will have own page, with all needed information in one location Revising pulldown menus for clarity Incorporating standalone content (such as the Administrator’s Handbook) as web pages Expanding and revising content throughout the site Open to other suggestions! Future Website Changes 20

Enhancements Can purchase an unlimited number of credits with a single transaction by the Data Bank Administrator Credits can be applied to continuous query enrollments and renewals or to one-time queries All authorized users can use the credits and check the balance Non-refundable, but never expire Automatic low-balance notifications for the Data Bank Administrator Prepayment for Queries 21

Enhancements Combined 3 pages into 1 Added a review step Allows users to confirm information before submitting 22 Query Form Online Account Self-Service Options to retrieve your password, user ID, or entity DBID without calling Customer Service sent with a link to the requested information – links are only valid for 1 hour

Enhancements View notifications for all entities on the options page Download all unviewed responses and disclosures at one time Create multiple additional enrollments for an existing enrollment Complete a query on behalf of multiple entities with one submission Agents and CVOs 23

Education

Education Forum Reporting: Current issues Query Response: Getting the most out of the NPDB through queries Research Applications: Using the NPDB research tools Guidebook: Overview Technology: See re-designed query screens and other new features Open Forum 25 Agenda Attendees: 150 Satisfaction: 85% highly satisfied

Recent Activities Staff participated in more than 18 webinars and in-person talks in 2015 Topics include: General education about the NPDB Guidebook specific Larger webinars may be recorded and shared online Informational webinar on the Guidebook with NAMSS (June, 2015) available on YouTube: 26 Active Speaking Schedule

NPDB Compliance

Focused primarily on licensing boards Community Health Centers Launching “Verification” in 2016 Small pilot program, then expanding Similar process will be used for next targets Hospitals and health plans in future years Focus on improving NPDB registration data and overall data integrity Compliance Activities 28

Resources Website: FAQs, brochures, and fact sheets NPDB Guidebook Recorded webinars Regulations Statistical data Research tools Instructions for reporting and querying NPDB Insights Help When You Need It 29 NPDB Customer Service Center

Questions 30

Elizabeth Lowery, MPH Policy and Disputes Branch Division of Practitioner Data Bank Bureau of Health Workforce Health Resources and Services Administration U.S. Department of Health and Human Services Telephone: Contact Information