Florida Association of Nurse Practitioners August 7, 2015

1. Florida Association of Nurse Practitioners August 7, 2015 Margarita Morales, MS U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce Division of Practitioner Data Bank

2. Presentation Overview National Practitioner Data Bank (NPDB) General Provisions Reporting and Querying Details • Reporting and Querying Overview • Hospital Querying • Hospital Reporting • Report Subjects • Potential Hospital Sanctions • Continuous Query NPDB Compliance NPDB Guidebook Resources Contact Information 2

3. General Provisions Purpose Created under three statutes to meet several needs: • Flagging system for effective credential reviews • Protection against unfit practitioners • Deter fraud and abuse in the health care system 3

4. General Provisions • The 3 statutes-- Title IV of Public Law 99-660, Section 1921 of the Social Security Act, and Section 1128E of the Social Security Act --remain in effect • ONE data bank • ONE set of regulations governing the NPDB’s operations Merger Goal: Eliminate duplication between the NPDB and HIPDB 4

5. General Provisions Types of Information Collected • Medical malpractice judgments, settlements • Adverse licensing, certification actions • Clinical privileges actions • Health plan contract terminations • Professional society membership actions • Negative actions/findings from private accreditation organizations and peer review organizations • Government administrative actions, e.g., exclusions from programs • Civil & criminal health care-related judgments 5

6. General Provisions Types of Transactions • Reporting (no charge) • Querying (by hospitals and health careorganizations) • $3 for a one-year continuous query subscription • $3 for a one-time query • Fees lowered October 1, 2014 • Self-Query (by an individual or organization) • $5 • Fee lowered October 1, 2014 6

7. General Provisions Recovering Costs • By law, the NPDB must recover the full cost of operations. It does so by collecting fees for each query. Confidentiality • Information reported to the NPDB is confidential, not available to the general public, and may not be disclosed except as provided by law. • Penalty up to $11,000 per confidentiality violation. 7

8. General Provisions Civil Liability Protection • Immunity provisions in Title IV, Section 1921, and Section 1128E protect individuals, entities, and their authorized agents from being held liable in civil actions for reports made to the NPDB unless they have actual knowledge that the information in the report is false. • Health care entity professional review bodies, their members, and their agents are immune from civil liability in most cases. 8

9. Reporting and Querying Details 9

10. Reporting and Querying Overview Required Not Authorized Optional 10

11. Hospital Querying Must query on: Health care practitioners when practitioners apply for staff appointments (courtesy or otherwise) or clinical privileges (including temporary privileges); every two years for practitioners on staff or with clinical privileges May query on: Health care practitioners with whom the hospital has entered (or maybe entering) employment or affiliation relationships 11

12. Hospital Querying • Centralized Credentialing • Querying Through an Authorized Agent • Delegated Credentialing • Continuous Query 12

13. Hospital Reporting Overview • Must report on: Physicians and dentists • Adverse clinical privileges actions >30 days related to professional competence or conduct • May report on: Other practitioners • Adverse clinical privileges actions >30 days related to professional competence or conduct 13

14. Hospital Reporting • Denials, reductions, and restrictions of privileges • Withdrawals and Non-renewals • Summary suspensions • Report forwarding to State Licensing Boards • Investigations • “While under investigation or in return for not conducting such an investigation” 14

15. Potential Hospital Sanctions Failure to Report Loss of immunity protections provided for professional review activities that occur during the 3-year period and organization name published in the Federal Register Failure to Query Plaintiff is allowed access to NPDB information on that practitioner for use in litigation against the hospital. 15

16. Report Subjects Approximate Number of New NPDB Reports Submitted On Individual Subjects From 2010 – 2014 by Profession 16

17. Reports by Profession

18. Continuous Query 18

19. Continuous Query Purpose • A subscription service that notifies subscribers of new information on any of their enrolled practitioners within one business day of the NPDB’s receipt of the information • Designed and developed to help meet new accreditation standards that require ongoing monitoring of practitioners • Since 2007, health care providers have enrolled more than 1.85 million practitioners 19

20. With Continuous Query • Service notifies subscribers of a report on their enrolled practitioners within one business day of receipt by the NPDB • By handling new reports as they are disclosed, subscriber organizations are always up to date. Subscribers can deal only with events that need attention, immediately resolving issues Continuous Query With One-Time Query • An average of 320 days pass between receipt of a report and disclosure of the report in response to a query. • Re-credentialing means re-querying practitioners and reviewing all results to identify new information – a tremendous amount of effort for large organizations. 20

21. Continuous Query Using Continuous Query • Requires the same practitioner information • Subscribers continue using their subject databases • Fee: $3.00 per enrollee per year • No separate query fee • Upon enrollment, receive the same report information as a one-time query response • Continuously queries the NPDB and notifies subscribers of any new reports • No need to re-query for reappointments or temporary privileges extensions 21

22. Continuous Query Endorsements • The Joint Commission • National Committee for Quality Assurance (NCQA) • Commission on Accreditation of Rehabilitation Facilities (CARF) • Utilization Review Accreditation Commission (URAC) • Centers for Medicare & Medicaid Services (CMS) Using Continuous Query helps meet obligations imposed by the Health Care Quality Improvement Act of 1986 (HCQIA). 22

23. NPDB Compliance 23

24. NPDB Compliance To date, NPDB compliance activities have focused primarily on licensing boards Licensing board process updated in January 2015 Currently shifting attention to other areas, in addition to ongoing licensing board efforts: • Medical malpractice • Health plans • Judgments/Convictions • Hospitals Increased focus on improving NPDB registration data and overall data integrity 24

25. NPDB Compliance State Board Adverse Action Comparison Impact (As of Dec. 2014) • New Reports are those submitted with effective dates during the time period being reviewed (2010-2012) and concurrent with the compliance effort • New Reports Disclosed represents the number of New Reports that have been disclosed as of December 2014 to queriers • Total Disclosures from New Reports represents the number of times the New Reports have been disclosed as of December 2014 to queriers 25

26. NPDB Compliance 2013-2014 State Board Attestation Results (as of Dec. 2014) 2010-2012 State Board Adverse Action Comparison Results (as of Dec. 2014) • Attestation occurs for each board every two years at registration renewal • Profession refers to state/profession combinations • Could Not Attest indicates a statement by the board that it could not attest that all reports have accurately been submitted • Failed to Attest indicates the board failed to provide a response for the profession • Review completed for the 12 most queried professions (i.e., nurses, pharmacists, physician assistants, podiatrists, psychologists, social workers, physicians, dentists, chiropractors, optometrists, physical therapists, and behavioral health professionals) in each state. Allied health professions (e.g., pharmacy technicians, nursing assistants, dental hygienists) were also included.

27. NPDB ReportsFlorida APRN vs. Physician NPDB Research Statistics: http://www.npdb.hrsa.gov/resources/npdbstats/npdbStatistics.jsp

28. Adverse Action by Report Type - Florida APRN Stahl, Anne L. National Practitioner Data Bank. Location by Payment Year. Generated using the Data Analysis Tool at http://www.npdb.hrsa.gov/analysistool. Jun 05, 2015. Data source: National Practitioner Data Bank (2013): Adverse Action and Medical Malpractice Reports (1990-2013)."

29. Adverse Action & Malpractice Payment- Florida APRN Stahl, Anne L. National Practitioner Data Bank. Location by Payment Year. Generated using the Data Analysis Tool at http://www.npdb.hrsa.gov/analysistool. Jun 05, 2015. Data source: National Practitioner Data Bank (2013): Adverse Action and Medical Malpractice Reports (1990-2013)."

30. Malpractice Payment TotalsFlorida APRN Stahl, Anne L. National Practitioner Data Bank. Location by Payment Year. Generated using the Data Analysis Tool at http://www.npdb.hrsa.gov/analysistool. Jun 05, 2015. Data source: National Practitioner Data Bank (2013): Adverse Action and Medical Malpractice Reports (1990-2013)."

31. NPDB Compliance Attestation Required at NPDB registration renewal for all boards licensing or certifying health care professions. Attestation has three parts: Review and update agency’s profile to reflect changes over the last two year period. Profession Verification: agencies review, verify, and update the list of professions they currently regulate. Certification: all agencies attest to their compliance with NPDB reporting requirements for each of their regulated professions.     31

32. NPDB Compliance Audit of Board Actions One-to-one audit of all professions representing 80% of query volume • Physicians (MD and DO) • Dentists • Physician Assistants • Advanced Practice Nurses • Registered Nurses • Social Workers Random selection of all other professions Sample drawn every two years Any other profession or board may be audited at the discretion of HRSA 32

33. NPDB Guidebook 33

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36. Key Changes What the new Guidebook does: • Blends Healthcare Integrity and Protection Data Bank and NPDB to reflect new combined regulations • Adds Section 1921 • Provides policy clarification What the new Guidebook does NOT do: • Make revisions that require legislative or regulatory changes • Accept or address every recommendation made by commenters. 36

37. Key Changes • Eligible entities • Definition of “Other Health Care Entity” • Registration requirements (use of DBIDs, User IDs) • Subjects of Reports • Definitions of health care practitioners, providers, and suppliers 37

38. Key Changes • Queries • Centralized credentialing • Delegated credentialing • Clinical vs. non-clinical privileges • Reports • Submitting reports • Corrections vs. revisions • Appeals 38

39. Key Changes • Reporting Medical Malpractice Payments • Oral vs. written claims • Identifying practitioners • Reporting Adverse Clinical Privileges Actions • Summary Suspensions • Proctors 39

40. Key Changes • Investigations 40

41. Key Changes • Reporting Adverse Professional Society Membership Actions • Expert witness testimony • Other adjudicated actions • Taken in conjunction with clinical privileges actions 41

42. Key Changes • Reporting Licensure and Certification Actions • Administrative fines • Summary/Emergency suspensions • Stayed actions • Denials • Withdrawals, and failure to renew while under investigation • Voluntary surrenders 42

43. Resources Help When You Need It www.npdb.hrsa.gov FAQs, Brochures, and Fact Sheets NPDB Guidebook Recorded Webinars Instructions for Reporting and Querying Regulations Statistical Data Research Tools NPDB newsletter NPDB Customer Service Center • 800-767-6732 • Email help@npdb.hrsa.gov NPDB Compliance Tip Line 301-945-9601 43

44. Questions 44

45. Contact Information Margarita Morales, MS Division of Practitioner Data Bank Bureau of Health Workforce Health Resources and Services Administration U.S. Department of Health and Human Services Telephone: 301-443-2300 Email: mmorales@hrsa.gov 45

46. Q & A Game 46

47. Subjects of Reports Question 1: • If a State board that regulates NPs issues a cease and desist order against a person who is not a NP but who is practicing as one, is the issuance of the cease and desist order reportable to the NPDB? 47

48. Subjects of Reports Answer 1: Yes. In this example, the State regulates the practice of NPs and prohibits individuals from practicing as NPs – even if they do not refer to themselves as NPs – without being licensed by the board. NPDB regulations require the reporting not only of individuals who are licensed, but also those who hold themselves out to be so licensed. Therefore, the cease and desist order issued by the board would be reportable. 48

49. Subjects of Reports Question 2: • Mercury Hospital’s peer review panel restricts a nurse practitioner’s clinical privileges for 30 days due to concerns about his ability to perform certain procedures safely. Is this reportable? 49

50. Subjects of Reports Answer 2: It depends. Clinical privilege actions/panel membership actions taken against a practitioner other than a physician or dentist may be reported. However, to be reportable, the action must adversely affect the practitioner’s clinical privileges for more than 30 days. 50