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ISMIE Helps Quash A Proposed NPDB Reporting Requirements |
Physicians won’t be unfairly targeted by an expanded reporting requirement for the National Practitioner Data Bank (NPDB), thanks to the concerted, seven-month lobbying efforts of ISMIE, the Physician Insurers Association of America (PIAA) and others. PIAA is the national trade association for physician-owned and operated insurance companies, of which ISMIE is a member.
At stake: The proposed NPDB rule would have required medical malpractice insurers and other health care entities to identify any practitioner whose professional conduct was at issue in an action or a claim, regardless of whether or not a claim or lawsuit was actually filed. The new rule would have applied even if the doctor wasn’t named as a defendant in the suit, or was dismissed from the case before payment was made.
Background: The Health Resource and Services Administration, a division of the U.S. Department of Health and Human Services, had suggested the rule to address a purported "corporate shield" loophole, which the administration alleged some health care entities theoretically could use to bypass reporting an individual practitioner to NPDB.
The issues at hand: ISMIE and PIAA felt the proposed rule would have forced insurers to make determinations of fault against every physician who provided care to the plaintiff patient. This would be true even if the physician in question was not insured by the reporting carrier. Also, the proposed change would have required insurers to conduct investigations and reach conclusions that are currently considered beyond their scope.
Action steps: As a result, ISMIE and PIAA sought assistance from members of Congress, and ISMIE found a strong ally in U.S. Rep. John Porter (R-Illinois).
Rep. Porter is the chairman of the Labor, Health and Human Services and Educational Subcommittee on Appropriations, which funds DHHS. He wrote to DHHS Secretary Donna Shalala and stated that DHHS should not implement the rule because it "reflects no effort to gather evidence on the scope of the so-called ‘corporate shield’ problem that it intends to address."
In addition, Rep. Porter wrote that the proposed rule "skirts the question of whether these changes are authorized" by the law, because the Health Care Quality Improvement Act of 1986 stipulates that malpractice carriers and health care entities provide the NPDB only with the name of any physician for whose benefit a payment was made.
VICTORY! HRSA Administrator Claude Fox, M.D., has announced that the rule has been withdrawn. This is a clear triumph for the PIAA and ISMIE. We will continue to watch for further developments in this area, with the help of Rep. Porter, as one of the many issues that ISMIE monitors on behalf of its policyholders.