The National Practitioner Data Bank (Data Bank) published an article in the May 2019 issue of NPDB Insights that provides significant guidance regarding when proctoring is reportable. Proctoring can come in many different forms and has several different names depending on the hospital, such as monitoring, mentoring, or preceptoring. Regardless of the name, hospital-assigned proctorship agreements can be a useful tool to help evaluate a practitioner when a hospital has concerns about clinical competence. This is especially true because certain proctorships can be structured to avoid a report to the Data Bank. When that is accomplished, hospitals are able strike a rare balance between adequately addressing competency concerns and not tarnishing a practitioner’s reputation and career.
According to the Data Bank, when a hospital is deciding whether it should report the assignment of a proctor, it should consider the role of the proctor and whether that role limits the practitioner’s privileges. A hospital should report proctoring if: (1) it is a result of a professional review action related to professional competence or conduct, (2) it is a limitation on the practitioner’s privileges, and (3) it is in effect for more than 30 days. As such, if as a result of a professional review action a hospital restricts a practitioner’s privileges for more than 30 days, it must be reported. A restriction is any action that limits a practitioner’s ability to practice independently.
The NPDB Insights article provides the example of a proctor that must approve a procedure before the practitioner may perform it as a reportable proctorship. The same goes for a proctorship where the proctor provides concurrent consultation (i.e. the practitioner and the proctor must agree on the procedure before administering care) or when a proctor is required to be physically present before the practitioner may provide care.
Conversely, a proctorship that is structured so that it does not restrict clinical privileges because the proctor is not required to be present for or approve procedures is not reportable. The same goes for proctorships that last 30 days or less or where the proctorship is routine and not the result of a professional review action, such as the proctoring of all new practitioners or those who have not performed a threshold number of a specific procedure.
As healthcare practitioners of all types have been learning, an adverse Data Bank report can do significant damage to a practitioner’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 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. As such, it is important for both hospitals and practitioners to understand the nuances in Data Bank reporting. This is especially true regarding proctorships as relatively minor differences when structuring the agreement can sometimes have a major impact in determining if it must be reported to the Data Bank. For additional information or assistance, contact Jesse A. Markos, Esq., at Wachler & Associates at (248) 544-0888.