NPDB: Investigation starts with an inquiry

The newest version of the NPDB Guidebook released last month includes stricter reporting requirements for when a physician surrenders privileges while under investigation. The NPDB has made the definition of “under investigation” more expansive, and it now includes when a physician is going through a focused professional practice evaluation (FPPE) for cause. If a physician surrenders privileges at an organization while under investigation, that organization must report it to the NPDB.

“If as soon as you start the FPPE process that starts an investigation, that is going to have a chilling effect,” says Elizabeth “Libby” Snelson, JD, Legal Counsel for the Medical Staff, PLLC, in St. Paul, Minnesota.

According to the Guidebook, “the NPDB considers an investigation to run from the start of an inquiry until a final decision on a clinical privileges action is reached. In other words, an investigation is not limited to a healthcare entity’s gathering of facts or limited to the manner in which the term ‘investigation’ is defined in a hospital’s bylaws. An investigation begins as soon as the health care entity begins an inquiry and does not end until the health care entity’s decision-making authority takes a final action or makes a decision to not further pursue the matter.”

The Guidebook also states that a practitioner does not have to be aware an investigation is being conducted in order to file a report with the NPDB if the practitioner surrenders privileges.

Snelson says this new requirement does not serve the intent of the databank, which is to catch bad physicians from leaving one hospital and going to another unnoticed. Snelson says if hospitals have robust and effective peer review systems, they may avoid  adverse action against a physician, and therefore not have to report a physician to the Data Bank. She sees this stricter reporting requirement having a negative effect on peer review systems.

According to Joanna P. Hopkins, Esq., attorney-at-law in Austin, Texas, other changes to the Guidebook that medical staff leaders and professionals need to be aware of include:

• The date for when a medical staff begins counting a summary suspension is the date the summary suspension is imposed, not the date the suspension is approved by a review body. (Summary suspensions longer than 30 days are reportable to the Data Bank.)
• If a physician cannot perform a procedure for more than 30 days without proctor approval or the proctor being present, that action is reportable. If the proctor is reviewing cases after a procedure is performed, this is not reportable.
• If a physician is granted temporary privileges and surrenders those privileges while under investigation, this is not reportable to the NPDB if the temporary privileges are time-limited and non-renewable.
   

The new Guidebook is available to download.