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Hospitals Will Soon Have Access to More Non-Physician Information

Elizabeth Jones, February 19, 2010

Hospitals will soon have access to non-physician practitioner information after the Health Resources and Services Administration (HRSA), a division of the U.S. Department of Health and Human Services (HHS), issued changes to Section 1921 of the Social Security Act that requires state licensing agencies to report non-physician and non-dentist practitioners to the National Practitioner Data Bank (NPDB) for any adverse licensure actions.

The changes will go into effect as of March 1.

The NPDB was created as a result of the Health Care Quality Improvement Act of 1986 in an effort to prevent problem physicians from sliding under the radar by jumping from state to state. In 1987, the Medicare and Medicaid Patient and Program Protection Act created a database in which the government could collect information regarding adverse licensing actions taken against healthcare practitioners and entities called the Healthcare Integrity and Protection Data Bank (HIPDB). The changes to Section 1921 bring the two databases together.

According to the Federal Register, Vol. 75, No. 18, January 28, 2010, other major changes to Section 1921 include:

  • State licensing agencies are required to have a system in place for reporting to the NPDB certain licensing actions taken against non-physician practitioners, such as revocation, reprimand, censure, suspension, and probation. These practitioners include chiropractors, podiatrists, pharmacists, physician assistants, optometrists, professional and paraprofessional nurses, physical therapists, respiratory therapists, and social workers. This change means that hospitals now have access to information that previously resided only in the HIPDB, which was designed to prevent healthcare fraud and abuse. Previously, only federal and state government agencies and health plans could access information in the HIPDB.

  • Healthcare accrediting agencies, state licensing authorities, and peer review organizations (PRO) must report negative actions or findings against healthcare entities (i.e., loss of accreditation status). Note: Peer review organizations are not the same as a peer review committee within a medical staff, says Jodi Schirling, director of medical and professional staff services at Nemours in Wilmington, DE. "PROs do external peer review on behalf of Medicare and Medicaid." In addition, PROs must provide due process rights following an adverse action before reporting any findings to the NPDB.

  • State licensing agencies are required to report healthcare practitioners for all types of actions taken against their licenses, not just those that are related to clinical competency. According to the Federal Register, "Section 1921 expands State reporting of licensure actions taken against physicians and dentists to the NPDB. … Currently, the [Health Care Quality Improvement Act] limits NPDB reporting by medical and dental licensing authorities only to those adverse actions related to professional competence or professional conduct, but these authorities must report all actions to the NPDB."

  • Medical malpractice insurers must report payments made on behalf of physicians, dentists, and other licensed healthcare providers. "If an RN is named in an insurance settlement, that insurance provider has to report that RN to the NPDB," says Schirling.

The changes to Section 1921 won't drastically change the daily lives of medical staff leaders or medical staff services professionals who are responsible for credentialing non-physician and non-dentist providers.

"I think we'll see that most of this is going to be handled through the HR process," says Schirling.

Many non-physician and non-dentist practitioners fall under HR, rather than the medical staff, which means that HR will need to query the NPDB when an organization hires non-physician licensed professionals.

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