In 1986, Congress passed the Healthcare Quality Improvement Act designed to provide federal immunity and protection for healthcare organizations and entities that provide good-faith peer review to physicians and dentists.
The quid pro quo was the creation of the National Practitioner Data Bank [NPDB] to "restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician's previous damaging or incompetent performance."
The NPDB has not been optimally effective. It received a high of 830 reports in 1991 and a low of 532 in 2006, or approximately 10 percent of the number as estimated by the Public Health Service (5,000) and the American Medical Association (10,000), according to Public Citizen's Health Research Group Report (2009).
The rationale given for under-reporting is that both healthcare organizations and physicians would like to avoid the professional damage and economic implications of triggering due process rights of a fair/judicial hearing and appellate review and a resultant NPDB report. Also, there is great variation among states in terms of state licensing board report requirements that may trigger a report to the NPDB.
Nevertheless, physicians are fearful of the potential professional and economic implications of a data bank report and it is commonly perceived that such a report may serve to effectively terminate a physician's career.
The American Health Lawyers Association (AHLA) and executive committee of the NPDB are currently performing collaborative research on this and the preliminary findings are significant.
Even with a formal uncontested report to the NPDB, more than 87 percent of these physicians have successfully resumed their professional careers, according to Harnam Singh, branch chief of research for the U.S. Healthcare Resources and Services Association (HRSA).
What are the key success factors that determine which physicians are most likely to succeed despite past performance or conduct issues?
Physicians who are willing to accept a measure of personal responsibility for past performance issues, disclose them in an honest and transparent manner, and work with healthcare organizations and medical staffs in a constructive way are most likely to succeed with or without a data bank report, noted Susan LaPenta J.D., partner at Horty, Springer and Mattern in Pittsburgh, Pa., and Michael Callahan J.D, partner at Katten, Muchin, and Rosenman in Chicago.
This does not mean a physician will have unlimited opportunities following a report and will not have to modify his or her expectations. Physicians with a history of corrective action have approximately a 50 percent chance of being successfully credentialed at a respected physician placement service and are better off reestablishing themselves at another healthcare organization with a good record for at least one appointment cycle (two years), according to Mark Robbins, operations manager at CompHealth in Salt Lake City, and Christy Potter, head of Quality Assurance at Weatherby Health in Fort Lauderdale, Fla.
Realistically, this may be a healthcare facility that is underserved and has significant need within a remote rural or inner city area. This may be psychologically challenging for some physicians, as it confronts them with the stark reality that what was once acceptable performance standards is no longer the case and that they must modify their style of practice if they wish to succeed in today's radically altered healthcare environment.
Thus, physicians who are subject to a report to the NPDB are most likely to succeed if they are willing to:
- Acknowledge past performance issues and take personal responsibility for them
- Disclose these issues to all relevant licensing boards, recruiters, healthcare organizations, medical staffs to demonstrate a willingness to openly share this information
- Work with such organizations to constructively address any relevant performance issues
- Acknowledge that seeking membership and clinical privileges reflects a voluntary desire to work with the organization constructively to continually improve the quality of care, conform to standards of behavior, and adopt evidence-based recommended clinical and administrative pathways as they become available and get approved by the healthcare organization
- Undergo appropriate remedial training if necessary or required through a formal re-entry process to confirm current clinical competence, knowledge of contemporary practices (e.g., EHR) and willingness to conduct oneself in accordance with professional standards
- Undergo any required remedial training to address behavioral issues or attitudes that led to the original action
This requires significant professional confidence and maturity to be able to acknowledge performance gaps and to address them in a respectful and thoughtful way. Those with this strength of character will likely succeed and those fearful of acknowledging changing professional standards will not.
Thus, the final question of "life after reporting" falls to the individual physician and to healthcare leaders who can hopefully guide the individual to an optimum and mutually beneficial result.
Jonathan H. Burroughs, MD, MBA, FACHE, FACPE is a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives. He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation's top healthcare consulting organizations to provide "best practice" solutions and training to healthcare organizations.