On Friday, October 26, 2018, the National Practitioner Data Bank (“NPDB”) quietly rolled out an updated October 2018 NPDB Guidebook. The last Guidebook was issued in April 2015, and at that time, had not been updated since September 2001. Prior to the April 2015 update, the NPDB issued a provisionary Guidebook for discussion and review. The October 2018 Guidebook was issued without notice.

The October 2018 Guidebook modifies language regarding the reportability of proctoring and adds a new section titled “Length of Restriction” under Chapter E: Reports, Reporting Adverse Clinical Privileges Actions. The changes appear to respond to a 2017 federal court decision finding a proctoring restriction was not reportable because it was not clear that the proctoring restriction would take more than 30 days. 

The October 2018 Guidebook also adds seven new Questions and Answers to the end of Chapter E. The new questions address reporting requirements concerning:

• Agreements not to exercises privileges while under investigation must be reported to the NPDB (Q. 22)
• Leaves of absence while under investigation must be reported to the NPDB (Q.23)
• Withdrawal of or resignation while a reappointment application is pending may be reportable (Q.24)
• Resignation while subject to a “quality improvement plan” may be reportable to the NPDB depending on the requirements of the plan (Q.25)
• A requirement that a surgeon operate only with a qualified first assistant may be a restriction of privileges and thus may be reportable if it runs more than 30 days (Q.31)
• A practitioner’s lapse of privileges at the end of a scheduled term, after a Medical Executive Committee’s recommendation to deny a reappointment application, but before hearing can be held on the recommendation may be reportable to the NPDB (Q.46)
• Guidance on updating NPDB reports modified by Court order (Q.49)

While we have highlighted the topics of the new Questions, the NPDB’s responses to these questions outline the circumstances when reports are required. 

Essential to medical staff, credentialing, and peer review, a key change in April 2015 was what some viewed as an expansion of the NPDB’s interpretation of what constitutes an “investigation.” The October 2018 Guidebook does not change this language.  

The October 2018 Guidebook is available for review and download at https://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp.