NPDB Reporting Requirements Shift for Employed Physicians

Some large health system–employed medical groups (and many larger independent group practices) are now establishing their own separate peer review bodies.

This article first appeared June 12, 2017 on Credentialing Resource Center.

Reporting to the National Practitioner Data Bank (NPDB) has nothing to do with a failure to meet some standard in an employment agreement, provided that there has been no similar action by a “peer review body” (generally understood to be the organized medical staff peer review process) or actions taken under the medical staff bylaws for investigation/suspension and so forth. Most of the time, this is the end of the subject; however, if you are part of a large health system/group practice, there are some new trends afoot that make life a bit more complicated.

A new rub is that some large health system–employed medical groups (and many larger independent group practices as well) are now establishing their own separate “peer review body” within the medical group itself. There are several reasons why this might be done:

• competency for practitioners strictly in the ambulatory setting who have only medical staff membership and no privileges. Such physicians are not subject to the organized medical staff’s peer review process.
• The desire to ensure physician competency strictly in the ambulatory setting for physicians who hold “ambulatory privileges” under the medical staff peer review process. Here the health system may decide to create a peer review function that truly understands the ambulatory world as opposed to devoting more resources to an inpatient-based medical staff peer review support function that has no knowledge of this setting.
• The desire to have a group practice–based entity to receive protected peer review information from the formal medical staff process through a peer review information sharing agreement.
• A poorly thought-through decision of the health system that they need to do something to ensure quality care in the ambulatory setting, so they create a new peer review body without fully thinking through the unintended consequences.

The creation of a “peer review body,” as defined by the Health Care Quality Improvement Act of 1986, that is separate from or independent of the hospital-based medical staff peer review body now subjects the employer potentially to the same NPDB reporting requirements. The health system would be wise to seek expert counsel in this arena and consciously and thoroughly think through what is being done and why. The good news for medical staff leaders is that you are responsible for the medical staff process only. What the health system does beyond the medical staff is its choice, for better or worse.