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Chapter 6: Future Endeavors and Projects

This Annual Report concludes with projects and activities planned for 2013.

Policy and Law

  • Affordable Care Act: Section 6403 of the Patient Protection and Affordable Care Act requires the Secretary of HHS to establish a transition period to transfer all data in the HIPDB to the NPDB and, once completed, to cease HIPDB operations. Information previously collected and disclosed through the HIPDB will then be collected and disclosed through the NPDB. The statute's intent is to transition HIPDB operations to the NPDB while maintaining reporting and querying requirements, to eliminate duplicative data reporting and access requirements between the NPDB and the HIPDB, and to streamline Data Bank operations.
  • Final Rule: In 2013, HRSA will publish a Final Rule in the Federal Register to implement Section 6403.
  • Privacy Act: In 2013, the Data Bank will publish a technical Final Rule revising a cross- reference cited in the Privacy Act to reflect changes made by the Final Rule merging the HIPDB and the NPDB.
  • Disputes Tracker: Disputes activities for 2013 include building features into the Disputes Tracker to cut down on paper files and reduce turnaround time. One such feature will be secure messaging, which will allow practitioners, entities, their respective representatives, and Dispute team members to communicate electronically, including sending and receiving supporting documentation. Team members also will be able to communicate electronically with each other in a secure Disputes system because a workflow feature will be established. Additionally, data reports will be generated electronically and in real time, with accompanying graphs and charts for use in presentations. A repository of closed cases with keyword search functionality will be built to group similar cases. The use of paper and postal mail will be reduced, as will time spent on cases, while increasing efficiency in the Dispute Resolution process.
  • Presentations: DPDB staff will conduct professional presentations, educational forums, and exhibits for Data Bank users and stakeholders across the country.
  • NPDB Guidebook: The Data Bank staff is developing an updated NPDB Guidebook, which will reflect the policy outlined in the statute and regulations that merged the NPDB and the HIPDB. The Guidebook is expected to be completed in 2013. This online version of the Guidebook will be primarily a policy document with hyperlinks to operations information on the NPDB website. This approach will facilitate periodic updates of information.

Compliance, Outreach, and Information Dissemination

  • Compliance Portal: Following the successful launch of a compliance website feature in 2012, the implementation of the new compliance framework will continue in 2013. The 12 most- queried professions will continue to be part of a one to one adverse licensure action matching process, whereby reportable licensure actions taken by an entity are compared to actual Data Bank reports. The reporting entities are divided by State into 4 semesters that are reviewed every 6 months. Half of the States will undergo a compliance review each year. This schedule results in each entity participating in compliance review activities for the 12 most-queried professions every 2 years. The compliance status for each reporting entity will be posted on the Data Bank public website each April and October.
  • State Licensing Board Attestation: Professions outside the 12 most-queried professions will be transitioned to a new attestation process that asks State licensing and certification boards to attest that they have submitted all reportable actions to the Data Bank as part of the entities' registration renewal process. The new process will be done electronically through a compliance attestation website feature, available when the entity signs in to the nonpublic Data Bank website. The entity may attest that it has met the reporting requirements; not attest that it has met the reporting requirements; or fail to attest, if the entity does not complete the new attestation process. The entity status will be posted on the Data Bank public website as received.
  • Hospital Compliance Initiative: The hospital compliance initiative will continue: Staff will complete the analysis of hospital data and conduct the necessary outreach to reach the goal of 100 percent compliance with hospital registration. Staff will develop an attestation process to use with hospitals to monitor compliance with querying and reporting requirements. Staff will develop a robust plan to conduct educational outreach activities targeted at specific audiences associated with hospital compliance involving querying and reporting to the Data Bank.
  • Medicaid Fraud Control Unit Compliance Outreach: A Medicaid Fraud Control Unit (MFCU) compliance initiative is being developed in coordination with the HHS OIG in the OIG's effort to conduct onsite performance reviews of MFCUs. Staff will develop a plan to conduct educational outreach activities targeted at MFCUs reporting to the Data Bank.
  • Criminal Convictions Compliance Framework: A health care-related criminal convictions compliance initiative is being developed to evaluate the completeness and accuracy of criminal convictions reported to the Data Bank by Federal, State, and local prosecutors.
  • Data Integrity: DPDB staff will continue to identify and address data integrity issues as they relate to information reported to and accessed from the Data Bank. Specific efforts will streamline various processes to promote accurate and complete data entry.

System-Level Enhancements

  • As part of DPDB's strategic planning effort, several key initiatives will be started in 2013, including usability studies and business process modeling analyses. These efforts will identify specific high-value opportunities for technology enhancements. Feasibility studies will be conducted on new technologies, such as business intelligence and dashboard software, geographic information system mapping software, document management tools, and cloud- based services. In 2013, internal process changes and software enhancements will be explored. Examples include streamlining the Dispute Resolution process, adding new point- of-entry data validation rules to improve data integrity, and improving screen design to help agents perform transactions faster and easier. These leading-edge solutions have the potential to generate significant efficiencies for customers and internal staff.

Research Efforts

  • Data Validation Project: The Research Branch is currently writing the statement of objectives to procure contracting services to examine the accuracy of information submitted to the NPDB. The project will evaluate the accuracy, completeness, and timeliness of NPDB data and assess DPDB's efforts to address potential underreporting to the Data Bank. The Research Branch is interested in using existing NPDB transactional administrative data in conjunction with outside data sources to obtain national estimates of potential transactions that would reside in the Data Bank in the absence of underreporting, non-reporting, and the use of practices such as corporate shield to avoid reporting medical malpractice payments to the NPDB. Given that unreported data are disproportionately distributed relative to State, report type, and reporter type, the branch is particularly interested in identifying innovative approaches (including statistical methodologies and modeling) to validate the completeness of the DPDB transactional administrative data, calculating national estimates of potential transactions that would reside in the Data Bank in the absence of loopholes, and computing national point estimates and their confidence intervals while controlling for the differences in State policies and regulations that affect both current and potential reporting of adverse actions and medical malpractice payments.
  • FSMB Data Project: The Research Branch has entered into an agreement with the Federation of State Medical Boards (FSMB) to receive data to use for research purposes. Merging these data with the NPDB administrative data will provide a robust data file that will be used to answer many research questions that cannot be answered using NPDB data alone. While the American Medical Association file that DPDB is using already contains physician-specific information, the FSMB data contains information on a wider range of topics – specifically, information about adverse actions against physicians.
  • New Coding Schemes for Adverse Action and Malpractice Payment Reports: The purpose of this study is to examine how reporting to the NPDB can be improved, particularly as it relates to coding of the reason (i.e., allegation code) for a malpractice payment or the type of and reason for (i.e., basis of action) an adverse action was taken. Entities submitting reports to the NPDB must provide a narrative description of the acts or omissions and injuries or illnesses for malpractice payments and the basis for the action when filing Adverse Action Reports. In addition to the descriptions, reporters must use a specified set of codes to classify the reason for a malpractice payment and the types of and reasons for a licensure or clinical privilege adverse action. Presently, a significant portion of reports of malpractice payments and adverse actions are classified as "Not otherwise classified (NOC)." This study will examine how the use of NOC and similar categories without specific reasons can be reduced.
  • Matching Algorithm: This project will improve data integrity of the NPDB by enhancing the algorithm used to match reports to reports, and queries to reports, on health care practitioners. Hospitals are required to query the NPDB when credentialing physicians and other practitioners. The NPDB uses an algorithm to score queries based on how closely the practitioner's name, date of birth, license number, and other data match existing NPDB records. For 97 percent of queries, the algorithm matches successfully. However, manually resolving the unmatched 3 percent (139,000 annually) is labor intensive and expensive. The Research Branch (in conjunction with the NPDB contractor) will develop a more sophisticated and precise algorithm based on prior data, using Bayesian statistics. The objective is to increase the match rate to 99.8 percent or higher, strengthen NPDB's confidence in the data, and lower contract costs.