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Reporting Peer Review Organization Negative Actions or Findings
Peer review organizations are required to report to the NPDB certain negative actions or findings. These negative actions or findings are defined in NPDB regulations as any recommendation by a peer review organization to sanction a health care practitioner. The health care practitioner must be licensed or otherwise authorized by the state to provide health care services. The actions taken must be a result of formal proceedings.
Peer review organizations also must report any revisions to a previously reported negative action or finding. For more information, go to Types of Reports in this chapter.
Various types of organizations, including but not limited to patient safety organizations and peer review consultants, may provide information, including recommendations, to hospitals and other health care entities. Unless these organizations meet the definition of a peer review organization, these organizations do not report their recommendations to the NPDB as peer review organizations.
Table E-15 outlines reporting obligations for peer review organizations.
| Law | Who Reports? | What is Reported? | Who is Reported? |
|---|---|---|---|
| Section 1921 | Peer review organizations | Negative actions or findings by peer review organizations | Practitioners |
Table E-16 provides examples of peer review organization negative actions or findings that should and should not be reported to the NPDB.
| Action | Reportable? |
|---|---|
| After an evaluation of a hospital's surgical services, a peer review organization formally recommends that the hospital temporarily suspend a surgeon's clinical privileges pending further investigation of the surgeon's professional competence. | Yes |
| A peer review organization, under contract with a hospital to conduct a review of several departments, reports a list of findings and overall recommendations on ways the hospital could improve quality of care; the peer review organization makes no recommendations to sanction a practitioner. | No |
| A hospital contracts with an independent organization for assistance in conducting a peer review of a practitioner. The independent organization, which does not conduct formal proceedings for physicians reviewed, provides a report with recommendations to the hospital's peer review committee for consideration. | No |
| A hospital's peer review committee makes an initial recommendation to impose a 15-day suspension of a physician's clinical privileges. | No |
| A peer review organization, under contract with a hospital to conduct a medical review of several departments, makes a formal recommendation that the hospital sanction one of its physicians based on evidence of patient abuse. | Yes |
Submitting a Copy of the Report to the State Licensing or Certification Authority
A copy of the report that peer review organizations receive after a report is successfully processed by the NPDB must be provided to the appropriate state licensing or certification authority.
