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Length of Action Requirement for Reporting Clinical Privileging Actions
Clinical privileges actions resulting from a professional review action that last longer than 30 days must be reported to the NPDB. The statute requires "a professional review action that adversely affects the clinical privileges of a physician or dentist for longer than 30 days" be reported. 42 U.S.C. § 11133(a)(1)(emphasis added). The NPDB has consistently interpreted adversely affects to mean the impact of the restriction, and not the manner the restriction is written.
If a physician's or dentist's privileges are adversely affected for longer than 30 days, the restriction must be reported, regardless of how the health care entity writes the restriction. For example, as described in the NPDB Guidebook, summary suspensions must be reported if imposed or in effect for longer than 30 days. However, reports submitted for summary suspensions, regardless of how the restriction was written, must be voided if the reported suspension did not ultimately last longer than 30 days. As is the case with any restriction, the reportability of the action is determined by the number of days privileges are restricted.
A health care entity may choose to structure a restriction based on when a health care practitioner demonstrates clinical competence, rather than attaching a specific timeframe to the action. A significant percentage of clinical privileging actions are reported to the NPDB as "indefinite" in length, placing the responsibility on the practitioner to demonstrate to the entity that he or she no longer needs the restriction. If such an adverse action is in effect for more than 30 days, it is required to be reported.
A restriction begins at the time a physician cannot practice the full scope of his or her privileges and is reportable to the NPDB once that restriction has been in place for 31 days. For example, proctoring may or may not be reportable depending on the type of proctoring and the length of time it is in effect. If a physician or dentist cannot perform certain procedures without proctor approval or presence, this is considered a restriction on privileges. The inability to practice the full scope of privileges without a proctor's presence or approval is a restriction. Once the physician or dentist is prohibited from performing the procedure without a proctor, his or her privileges are adversely affected. The number of cases required to be proctored at the time of imposition, or the expectation that a restriction be concluded in fewer than 31 days, is irrelevant for reporting purposes. The reportability of the action hinges on whether the restriction is in fact in effect for a period longer than 30 days.
