Hospitals Leave National Practitioner Data Bank Dangerously Short on Data

Public Citizen put together an important report in May that was mostly missed by the press (including me).

It's a comprehensive and critical investigation of The National Practitioner Data Bank (NPDB), created by the Health Care Quality Improvement Act 19 years ago, ostensibly to protect patients from rogue doctors.

The NPDB has been tantalizing and frustrating for health reporters. Hospitals are supposed to report most doctor discipline to the NPDB, creating a massive coast-to-coast compilation of doctors behaving badly. Unless you are a hospital or other health care employer, though, you don't have access to the doctors' names, undercutting the power of the database considerably. Some news organizations — most famously the Hartford Courant — have found ways to work around this.

Now Public Citizen shows us that the data that has been gathered by the NPDB is dangerously weak:

As of December 2007, almost 50 percent of the hospitals in the U.S. had never reported a single privilege sanction to the NPDB. Prior to the opening of the NPDB in September 1990, the federal government estimated that 5,000 hospital clinical privilege reports would be submitted to the NPDB on an annual basis, while the health care industry estimated 10,000 reports per year. However, the average number of annual reports has been only 650 for the 17 years of the NPDB's existence, which is 1/8th of the government estimate and about 1/16th of the industry estimate.

The report also performs an invaluable service by holding the health care community accountable for past promises that have been broken. An Office of Inspector General report at the Department of Health & Human Services in 1996 found big differences in how various states reported.

In response to the OIG report, HRSA convened a national conference in October 1996 of many stakeholders such as the American Hospital Association, American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations ("Joint Commission"), Center for Medicare and Medicaid Services, Public Citizen and OIG. The consensus report from the conference found that the number of reports in the NPDB is unreasonably low, compared with what would be expected if hospitals pursued peer review effectively.

Collectively, the OIG report, the 1996 national conference, and a 2002 HRSA funded study of hospital compliance made a total of 10 different recommendations to remedy this serious problem. However, as of December 31, 2008, only one of the recommendations has been fully implemented.

Can it get much worse than only one out of 10 in 12 years?

Public Citizen makes some strong recommendations of its own, including new Medicare rules that would force hospitals to comply with the NPDB requirements and a $25,000 civil penalty for failure to report. The fine is something the OIG recommended back in 1999.

Again and again, this report shows how important it is for legislators and reporters to follow through. Health writers everywhere should go through recommendations like this at the local, state and national level a few years after they are announced and see what has really been done. If you need to know why it's important to make it difficult for doctors fleeing trouble to jump from state to state without consequences, read through a few of my bad doctor posts.

One of the most interesting findings in the report is the clear differences that continue to exist between hospitals in different states, indicating that peer review of doctors can be affected by the culture of an area. This is an area that intrepid writers could and should explore. On average, about 49% of all hospitals in the country have never reported a physician to the NPDB. One might expect a small minority of hospitals to have not had occasion to do so, but half? Someone in Wyoming, Louisiana, North Dakota, Montana and Kansas needs to investigate why about 70% of the hospitals there have never made a report to the NPDB. And, at about 60%, Alabama, Hawaii, Idaho, Iowa, Minnesota, Mississippi, Nebraska, Nevada and Texas all deserve some digging, too.

If you want to see the full list, go to page 38 in the report.

The National Practitioner Data Bank will only improve if we keep the people reporting to it honest.