Update & Thoughts on Reforming National Practitioner Data Bank
Last Spring (2012) Sorry Works! launched a campaign to kick start a discussion on reforming the National Practitioner Data Bank (NPDB) and state licensure boards. In short, we argued (and still argue) that the NPDB and state licensure boards need to be changed/reformed to reflect the reality of the growing disclosure movement. A clinician who makes an honest mistake, admits fault, and apologizes and compensates should be treated differently than a clinician who attempts to cover up a mistake, and much differently than a clinician engaged in reckless or even criminal behavior. The NPDB basically has a "one-size fits all" approach to paid claims, which hospitals and insurers try to work their way around. Whereas overworked, underfunded state licensure boards could see disclosure cases as low hanging fruit and, to appease consumer groups, get tough on honest docs. Clearly we need to do work on both fronts. This past Spring (2013), Oregon became the first state to successfully address disclosure and licensure boards, and Sorry Works! supported their efforts. At least one other state is contemplating similar language, and more will surely follow. This is good.
As for the NPDB, word on the street is that federal leaders are considering changes/updates to the NPDB in light of the disclosure movement. This is good. A few thoughts for federal leaders: 1) The original premise of NPDB of not allowing deficient clinicians to skip from state to state without tracking is good; 2) One study says, on average, 1 in 5 physician hiring or retention decisions are provided more information (i.e, information left out by the applicant physician) due to the NPDB; 3) As I travel the country I think where the rub comes with NPDB is all clinicians are lumped together -- "bad" and "good." Sure, nobody - including MDs - wants to see deficient clinicians skip from state to state harming countless patients and families. The problem is when a otherwise competent/good doctors make a mistake they can be put in the NPDB too -- and data shows since the NPDB's inception settlements are down and time to resolve cases has gone up. Good docs are digging in their heals more often when hit with a claim. Cases take longer to settle or reach trial - if ever - and learning from mistakes is slowed, meaning more patients are needlessly harmed. This is not good. The NPDB apologists like to say "the NPDB is only a messenger...only a data base." That's a lazy answer. Very lazy! In my book, that answer ranks up there with the response I get from my seven-year old when I inquire how his day was at school: "I dunno know. I forgot." In its current state, the NPDB represents reputational harm to docs...and reputation is everything for docs, especially the good ones!
So, how do we preserve the original intent of the NPDB - keeping deficient clinicians from skipping state to state - without smearing otherwise good docs, especially with disclosure taking root? How do we track the bad apples while not creating an impediment to settlement in cases involving otherwise good docs and honest mistakes? Also, how do we account for system failures as opposed to individual failings?
It's not easy...lots to think about. Lots of politics too. To accomplish this task there will probably need to be some parameters put in place and other ways to make the NPDB (and also state licensure boards) more sophisticated in evaluating cases. As part of our campaign we offered suggestions for changing the NPDB (and also licensure boards), which ignited a bit of a firestorm among some patient safety advocates. My reaction to these folks was in their singular focus on chasing truly bad apples they are a) delaying justice in many cases, which hurts consumers as well as providers, and b) chilling the disclosure movement which hurts patient safety efforts. Interestingly, many plaintiff's lawyers and risk managers agreed with my arguments. I also argued that our criminal courts routinely differentiate cases....honest mistakes with contrition are handled much differently than cases involving no remorse, frequent flyers, etc. Can't we expect the same level of sophistication with the NPDB and licensure boards?
I'm glad the discussion is happening with the NPDB. Hopefully this post will provide more fodder for the discussion. Sorry Works! is ready to help that discussion, and we encourage others to let their voices be heard. This is important!
- Doug Wojcieszak, Sorry Works! Founder
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