The National Practitioner Data Bank Guidebook Provides Clarity on Reportable Events

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adrienneClinton

By Adrienne Dresevic, Esq. and Clinton Mikel, Esq. of the Health Law Partners, P.C.

The National Practitioner Data Bank (“NPDB”) is a repository of reports requiring hospitals and other entities with peer review committees, health plans, etc. to report adverse actions related to health care practitioners, providers, and suppliers to the centralized database. Most relevant to this article is the required reporting of adverse actions related to a limitation on a practitioner’s clinical privileges. The NPDB Guidebook (available for download here) provides interpretation of NPDB requirements for mandatory report entities. On October 26, 2018, the Guidebook was updated for the first time since April 2015. While, many of the October 2018 updates to the NPDB were editorial changes, there were also modifications made regarding what is considered a reportable surrender of clinical privileges, as well as other reporting descriptions. Ultimately, these changes will likely lead to more reporting events of physicians. This article will highlight some of the relevant changes to the NPDB which radiologists and mandatory reporting entities should be aware.

By way of background, the NPDB requires the reporting of certain adverse actions to the centralized database by hospitals and other entities with peer review committees, health plans, and others. Reporting, or failing to report, to the NPDB poses serious consequences to both mandatory report entities and practitioners that are reported to the NPDB. Whether an entity reports properly or improperly, it may face lawsuits from reported practitioners. Conversely, there may be lasting career and reputational effects for reported practitioners who appear on the NPDB (properly or improperly). Further, radiologists and other practitioners should be aware that certain actions (e.g., a leave of absence restricting privileges during an investigation) will be considered a reportable event according to new guidance issued by the NPDB.

Under the NPDB Guidebook, a practitioner’s clinical privileges include privileges, medical staff membership (e.g. access to physicians’ dining room, hospital library, CME classes, and voting rights), and other circumstances in which a health care practitioner may furnish medical care by a health care entity.

The October 2018 changes occurred predominately in Chapter E: Reports, Reporting Adverse Clinical Privileges Actions, with the addition of a new Chapter E: Reports section, “Length of Restriction”. This section clarifies that if a professional review action affects the privileges of a practitioner in a negative way for longer than 30 days, it is reportable, regardless of how a restriction order is written. This update appears to be in response to a 2017 federal court ruling that found a proctoring restriction was not reportable because it was not clear the restriction would take more than 30 days.

Additionally, the updates added several new Questions and Answers to the conclusion of Chapter E: Reports, Reporting Adverse Clinical Privileges Actions which provide clarity in certain situations.  Some examples which may be of relevance to radiologists and reporting entities include the following:

  • 22: An agreement not to exercise privileges during an investigation is reportable.
  • 23: A leave of absence that restricts privileges during an investigation is reportable.
  • 24: Withdrawal of a pending reappointment application may be reportable if any inquiries fall outside of what would be considered a routine review.
  • 25: Depending on the requirements of the plan, resignation while under a “quality improvement plan” may be reportable.
  • 46: A practitioner’s lapse of privileges at the end of a scheduled term may be reportable if a hearing has not yet been held on a Medical Executive Committee’s recommendation to deny a reappointment application.

While the NPDB Guidebook serves only as an informational policy manual for the health care community, it greatly influences reporting standards for the NPDB.

In light of these changes to the NPDB, radiology providers and suppliers should remain cognizant of this new guidance to carefully consider whether certain events will potentially trigger reporting requirements which could have very negative consequences for any practitioner.


Adrienne Dresevic, Esq. is a Founding Shareholder of The Health Law Partners, P.C., a nationally recognized healthcare law firm with offices in Michigan and New York. Practicing in all areas of healthcare law, she devotes a substantial portion of her practice to providing clients with counsel and analysis regarding compliance, Stark Law, Anti-Kickback Statute, and compliance related issues. Ms. Dresevic serves on the American Bar Association Health Law Section’s Council, which serves as the voice of the national health law bar within the ABA. Ms. Dresevic also serves as the ABA Health Law Section’s Co-Chair of the Physicians Legal Issues Conference Committee, Vice Chair of the Programs Committee (Executive Leadership), and Vice Chair of the Sponsorship Committee. She is licensed to practice law in Michigan and New York, and can be contacted at adresevic@thehlp.com. 

Clinton Mikel, Esq. graduated from the University of Michigan Law School. Practicing healthcare law, he concentrates in Stark, fraud/abuse, telehealth/telemedicine, compliance, and the corporate and financial aspects of healthcare practice.

The authors are members of The Health Law Partners, P.C. and may be reached at (248) 996-8510 or (212) 734-0128, or at www.thehlp.com.

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