NPDB reporting requirements for PAs and NPs

Hospitals and medical staffs are confused whether they need to report adverse actions against nurse practitioners (NPs) and physician assistant (PAs) to the National Practitioner Data Bank (NPDB). Here are some simple steps to follow that should guide your actions.

First, the Health Care Quality Improvement Act of 1986 does not require hospitals to report adverse actions taken against PAs and NPs to the NPDB. It does, however, mandate that hospitals report adverse actions taken against physicians and dentists to the NPDB. Section 1921 of the Social Security Act mandates that state licensing boards, peer review organizations, and private accreditation organizations—not by hospitals—report adverse actions taken against NPs and PAs. Although more information will be available to hospitals when they query the NPDB regarding NPs and PAs, they do not have to report NPs and PAs to the NPDB.

Second, hospitals and medical staffs may consider whether they wish to voluntarily report adverse actions taken against NPs and PAs. Although no mandate exists, some feel that it is the right thing to do for their organization (e.g., an adverse action taken against an anesthesiologist is reportable while the same action taken for the same reason against a CRNA is not mandatorily reportable). It is at the discretion of the hospital and medical staff whether to report these actions voluntarily.

But there is a third factor to consider: Accreditation agencies, such as The Joint Commission, currently allow different fair hearing and appeal processes for members of the medical staff and nonmembers. Medical staffs can extend the proscribed fair hearing and appeal mechanism outlined in HCQIA, while nonmembers who are not physicians or dentists could have a simpler process. If your medical staff wishes to report an NP or PA to the NPDB, you will want them to have the same fair hearing and appeal process that members have. This is done to obtain the immunity protections offered under HCQIA, the same act that created the NPDB.

All of this means that before instituting an adverse action against an NP or PA, you need first to know whether you will want to report this action, if taken, to the NPDB.  This decision will then guide which fair hearing and appeal mechanism your medical staff should follow.
 

Mary Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Danvers, MA.