By JESSE MARKOS
The National Practitioner Data Bank has published an article in a recent version of NPDB Insights to help clarify when a hospital privileging action is reportable to the Data Bank. Since a Data Bank report can have significant professional and economic ramifications, it is important for all healthcare providers to understand when a report is required and when one can be avoided.
By way of background, the Data Bank is an alert system that collects and discloses certain adverse information about physicians and other healthcare providers. An adverse report to the Data Bank can significantly impact a health care provider’s reputation and career. State licensing authorities, hospitals and other health care entities, and professional societies search the Data Bank when investigating qualifications. A response that contains an adverse report can act as a permanent blackmark and result in a denial of credentialing, loss or limitation of hospital privileges, loss or limitation of licensure, exclusion from participation in health plans, and increases in premiums or exclusion from professional liability insurance.
NPDB Insights is published by the Data Bank to serve as a forum to provide updated guidance to users on topics such as eligibility, querying and reporting requirements, and the dispute process. The December 2018 version of NPDB Insights was published, in part, to clear up any uncertainly regarding reporting requirements, including whether or not a leave of absence while under investigation is considered to be a resignation of privileges that is reportable. According to the guidance in NPDB Insights, if a leave of absence while under investigation restricts privileges, it is reportable. NPDB regulations state that the acceptance of the surrender of clinical privileges, or any restriction of such privileges, is reportable. As such, a leave of absence that restricts a practitioner’s ability to exercise privileges, is considered a surrender and is reportable. Importantly however, the guidance in NPDB Insights goes on to say that if a practitioner can take a leave of absence without affecting his or her privileges, and his or her privileges remain intact during the leave of absence, the leave of absence is not reportable to the NPDB. This is important because it potentially provides an opportunity for practitioners to take a leave of absence during an investigation without inviting a Data Bank report so long as the hospital does not consider the leave of absence to affect the practitioner’s privileges.
Avoiding a Data Bank report is a central concern for many health care providers as a report can have serious professional and financial repercussions. As a result, hospitals and healthcare providers alike must become familiar with the reporting guidance found in NPDB Insights to help understand when a report is required and how, if possible, one can appropriately be avoided. For additional information or assistance, contact Jesse A. Markos, Esq., of Wachler & Associates, P.C., at (248) 544-0888.