MedPage Today Investigation Highlights Gaps in Credentialing Process

Instances of incompetent or malicious practitioners have always made headlines, but rarely are the wider systemic issues discussed that allow such events. A recent investigation by MedPage Today and the Milwaukee Journal-Sentinel catalogued at least 500 physicians from 2011-2016 who exploited gaps in the medical licensing system to avoid sanctions or red flags.

In these instances, doctors who had actions taken against them by one state medical board were able to “slip through the bureaucratic net” and operate under clean licenses in other states. Physicians who had formal complaints, suspended licenses, or even permanent revocations maintained their licenses with other state boards, many of whom were not even aware of the action in the first place.

MedPage Today found that the majority of state boards only report their own disciplinary actions against physicians. Their investigation, titled “States of Disgrace: A Flawed System Fails to Inform the Public,” outlines seven categories of information on physician history, including state medical board disciplines, discipline by other states, malpractice claims/payouts, loss of privileges, criminal convictions, Medicare and Medicaid exclusions, and DEA/FDA actions.  Only five states (Florida, Kansas, Massachusetts, Maryland, and North Carolina) regularly reported six of the seven – no state routinely checked and reported all of the above.

The National Practitioner Data Bank, which was created to serve as a central identifying tool for all adverse actions, has not fulfilled its promise of transparency, according to MedPage. A survey conducted by the former NPDB research director found that few state boards made regular queries of NPDB – most states performed only 10 to 20 searches a year, and some didn’t submit any at all. High costs may make NPDB searches prohibitive for some states, but this can result in severe lapses in the information they hold about physicians who are licensed in their states, leading to gaps that can affect patient safety. Out of 64 state medical boards, only 13 subscribed to the “Continuous Query” service which provides alerts for new updates to physician records.

“States of Disgrace” emphasizes the issues that stem from the patchwork system of state licensing boards, but also flags the problem of physicians omitting relevant information in their own applications – whether for licensing or privileging directly at a hospital. NPDB’s survey found that almost 10% of the time, organizations querying the Database found new information about the physician, which shouldn’t occur if the physician was fully forthcoming in their application. “They should never find anything new in an NPDB report,” says Dr. Robert Oshel, formerly of NPDB. This problem is faced in credentialing offices across the nation as well. While it can’t fill in every gap, NAMSS PASS provides a unique ability to understand a practitioner’s full affiliation history, and can protect patient safety by guarding against reticent applicants. Find out more about NAMSS PASS here.