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Q&A: Eligible Entities
Are PCMHs eligible to participate in the NPDB as a health care entity?
In order to be eligible to participate in the NPDB as a health care entity, an organization must meet one or more of the parts of the definition. It must be:
- A hospital
- An entity that provides health care services and engages in professional review activity through a formal peer review process for the purpose of furthering quality health care, or a committee of that entity, or
- A professional society, or a committee or agent thereof, including those at the national, state, or local level, of health care practitioners that engages in professional review activity through a formal peer review process, for the purpose of furthering quality health care
For purposes of the second bullet of the definition above, an entity includes an HMO that is licensed by a state or determined to be qualified as such by HHS, and any group or prepaid medical or dental practice that meets the criteria of the second bullet.
A formal peer review process is the conduct of professional review activities through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing.
PCMHs normally would be considered to be "providing" health care services. If the PCMH provides health care services and also conducts formal peer review to further the quality of health care, it would be eligible to participate in the NPDB as a health care entity and would be required to report.
