Members of the House of Representatives Commerce Committee are divided over whether the federally managed National Practitioner Data Bank (NPDB) should be open to the public. However, they agree that improvements are needed to make the NPDB more effective.

To restrict the ability of incompetent physicians to move from state to state, Congress legislated the creation of the NPDB in 1986. The goal was to provide a national resource for hospitals, state licensing boards, and other health care entities to check the credentials of physicians and other practitioners.

The electronic database now contains about 100,000 records on physicians including medical malpractice payments and adverse actions regarding their licensure, clinical privileges, and professional society memberships, according to Thomas Croft, who oversees the NPDB as director of the Division of Quality Assurance in the Bureau of Health Professions, an agency of the Health Resources and Services Administration (HRSA).

Croft testified last month before the House Commerce Subcommittee on Oversight and Investigations chaired by Representative Fred Upton (R-Mich.). This was the second of two subcommittee hearings on whether the NPDB should be open to the public.

Croft commented on the significant growth in the number of users of the NPDB, but conceded that there is room for improvement. Approximately half (4,000) of all hospitals registered with the NPDB have never reported a single disciplinary action against a doctor, according to his written testimony.

Hospitals are required by law to report adverse actions taken against a practitioner to the NPDB and to check the NPDB before granting privileges to a medical practitioner, according to an NPDB fact sheet.

Representative Tom Bliley (R-Va.), chair of the Commerce Committee and a strong advocate of making the NPDB public, stated in written testimony to the subcommittee, "I am disturbed by Croft’s report and by the fact that since 1990, when HRSA began operating the Data Bank, only two hospitals have ever been warned about their failures to report clinical privilege actions to the NPDB."

Croft responded that "HRSA will soon contract with an accounting firm to develop a plan for auditing hospital records so that required data can be efficiently collected and analyzed."

He added that HRSA is considering penalizing hospitals monetarily for failing to report disciplinary actions against practitioners to the NPDB, which would require a legislative amendment, according to Croft’s statement.

He reminded the subcommittee, "The data collected are meant to supplement a comprehensive and professional peer review rather than serve as an independent determination of a physician’s competence. There are also privacy concerns about broad disclosure of potentially incomplete negative information."

AMA President Thomas Reardon, M.D., testified before the subcommittee that Congress never intended the NPDB to be a resource for patients. "Simply opening the data bank and disseminating raw, unsynthesized legal data would not help patients," he maintained.

Reardon also testified that malpractice claims seldom correlate with findings of negligent care. "A New England Journal of Medicine study indicates that only one in five [malpractice] settlements results from negligent medical care."

The AMA president recommended that the subcommittee enhance the efforts of state licensing boards and the Federation of State Medical Boards to create information systems on physicians that patients can use.

Bliley responded, "Can the AMA or other opponents of public access tell patients who have suffered horribly because of medical malpractice that the next time they choose a physician, they still should not be allowed to view the critical information about doctors that the federal government already collects in the data bank?"

Bliley advocated working with HRSA to correct problems in the current system and using state physician profiles as a model.

At least 11 states have enacted laws to make physician profiles available to the public, according to a statement by Barbara Neuman, president of Administrators in Medicine, who testified before the subcommittee last month.

The typical physician profile has information on medical malpractice, criminal convictions, and hospital and board disciplinary actions. The sources are state medical and osteopathic boards and other states with physician profile laws, according to Neuman’s statement.

Upton essentially sided with the AMA. "Opening the data bank to the public including trial lawyers could," he noted, discourage doctors from going into high-risk medical fields."

"The number and size of malpractice payments may not necessarily indicate a doctor’s competence. Insurance companies often settle out of court rather than go to trial in spite of compelling evidence that the physician’s care was appropriate," according to his statement.

Instead, Upton said he would introduce legislation soon to address problems in the credentialing and licensing system, which is largely state based. The legislation’s provisions would do the following:

• Provide grants to states to ensure the prompt and expert review of all reports and complaints that may warrant disciplinary action.

• Require states to query the NPDB whenever a physician licensed in another state seeks additional licensure.

• Improve communication between the Medicare Professional Review Organizations and state medical boards and require Medicaid agencies to share case information with state medical boards.

• Ensure that Health Care Financing Administration insurance intermediaries are referring cases of apparent unethical practice or unprofessional conduct to state medical boards.

• Require all physicians to participate in a professional peer review process as a condition of Medicare and Medicaid participation.

• Require the Drug Enforcement Administration to release a monthly report to all state medical and pharmacy boards on all practitioners whose licenses for controlled substances were revoked, surrendered, restricted, or denied.