Malpractice: provider risk or consumer protection?

The National Practitioner Data Bank (NPDB) began operation in September 1990 as a clearinghouse for adverse action, licensure, and malpractice information in an effort to protect consumers and promote quality in health care. This study analyzed 66,107 and 1291 records of payments made for 50,396 physicians and 1218 nurses, respectively, from 1994 through 1998, to describe characteristics, trends, and risk factors of malpractice payment for physicians and nurses. The median payments, more often settlements paid by insurance companies than judgments in courts of law, were higher for physicians than for nurses. Mean payments were higher for residents than for non-resident physicians; median payments for residents were slightly lower than other physicians when adjusted for number of providers included in the payment. On the state level, correlation analyses suggested a significant positive association between the nurse rate of malpractice payments that were made and median per capita income, number of physicians per 1000 residents, and number of attorneys per 1000 residents; analysis revealed a significant negative association between this rate and the percentage of residents residing in rural areas and the number of nurses per 1000 residents. Although findings suggested that payment trends remained stable, there was great regional variation in the risk of malpractice payment for both physicians and nurses. The physician risk ranged from a low of 0.73% per physician per year in Alabama to a high of 3.7% in Wyoming, and the nurse risk ranged from a low of 0% per nurse per year in Vermont to a high of 0.075% in the District of Columbia. If the quality of health care provided by physicians and nurses does not vary geographically in the United States, then such a great discrepancy seems to challenge the notion that the risk of malpractice litigation consistently promotes the quality of health care.

Disciplining physicians: what every physician and health care administrator needs to know about the Health Care Quality Improvement Act

This article highlights the critical provisions of the Health Care Quality Improvement Act that must be considered by physicians and health care entities in conjunction with disciplinary actions. These include: when professional review actions are covered by the Act's immunity; what constitutes adequate notice and a fair hearing for affected physicians; when professional review actions should be reported to the National Practitioner Data Bank; and what must be reported.

The inefficiencies of present systems for physician credentialing

The requirements of physicians credentialing have become standardized through the broad acceptance of the credentialing standards developed by the major accrediting bodies. However, attempts to share credentials documentation and data have been few, resulting in much redundancy among credentialing programs and excessive application paperwork for physicians. This article describes recent initiatives in the standardization of application forms and office site reviews and in the sharing of physician data. Also discussed are questions that have been raised in recent years about the value of some information that has traditionally been considered in physician credentialing.

Privacy Act; implementation. Office of Inspector General (OIG), HHS. Final rule

This final rule exempts the new system of records, the Healthcare Integrity and Protection Data Bank (HIPDB), from certain provisions of the Privacy Act (5 U.S.C. 552a). The establishment of the HIPDB is required by section 1128E of the Social Security Act (the Act), as added by section 221(a) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Section 1128E of the Act directed the Secretary to establish a national health care fraud and abuse data collection program for the reporting and disclosing of certain final adverse actions taken against health care providers, suppliers or practitioners, and to maintain a data base of final adverse actions taken against health care providers, suppliers and practitioners. Regulations implementing the new HIPDB were published in the Federal Register on October 26, 1999 (64 FR 57740). The exemption being set forth in this rule applies to investigative materials compiled for law enforcement purposes.