September 13, 2011
Mary K. Wakefield, Ph.D., R.N.
Health Resources and Services Administration
Department of Health and Human Services
5600 Fishers Lane
Rockville, MD 20857
Dear Administrator Wakefield:
Public Citizen is quite concerned that the Health Resources and Services Administration (HRSA) recently removed the National Practitioner Data Bank (NPDB) Public Use Data File from the NPDB’s website. HRSA has made this data file available to the public for more than 15 years and has updated it quarterly. In the past few months, however, updates to the file have not been posted in a timely fashion. Most recently, the March 31, 2011, version of the file, which was posted very late, was removed from the website shortly after it was posted. This action is very troubling to us. Loss of access to the NPDB Public Use Data File eliminates an important tool used by health care researchers, patient safety experts, and policy analysts to identify important trends and systematic problems involving the delivery of health care by physicians.
Over the years, the NPDB Public Use Data File has proved to be quite valuable to Public Citizen’s research. It also has served as the basis for an ever-increasing number of articles on malpractice, medical errors, and medical discipline in peer-reviewed scholarly journals and other professional publications. The file is the only comprehensive national source for reliable data on medical malpractice and other matters reported to the NPDB. The continued availability of this data is crucial to patient safety and research aimed at informed public policy decisions concerning malpractice, tort reform, peer review, and medical licensing. There simply is no substitute for the NPDB Public Use Data File if this vital research is to be continued.
Section 427(b)(1) of the Health Care Quality Improvement Act of 1986 states that “Information reported … that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary … on application by any person, shall prepare such information in such form and shall disclose such information in such form.” HRSA has considered this language to mandate issuance of a Public Use Data File since the beginning of the NPDB. This language also served as the basis for HRSA’s ongoing program to respond to research requests from the public and to prepare special versions of the Public Use Data File in response to specific requests from researchers for data not in the generally distributed file.
We particularly note that HRSA’s issuance of the Public Use Data File always has been considered to be in compliance with the law in that it does not contain data that identifies or permits identification of any particular physician, health care entity, other health care practitioner, or patient. Even with specific information from other sources, it is impossible to tie with any degree of certainty the records in the Public Use Data File to a physician, health care entity, other health care practitioner, or patient identified in other sources, since the records in the Public Use Data File do not contain exact payment amounts, dates of payments or actions, practitioner ages, years of graduation, etc. All these variables are provided only in broad ranges in the Public Use Data File.
We also find it ironic that at a time in which other parts of the Department of Health and Human Services (HHS) are becoming more transparent and even proposing to make detailed ratings of health care entities and providers available to the public, HRSA appears to be restricting access to information mandated by law to be made public.
Finally, HRSA’s decision seems inconsistent with current HHS initiatives to improve patient safety, including the development of a National Quality Strategy and the Partnership for Patients. For example, one important goal of the National Quality Strategy is to reduce harm caused in the delivery of care.
We urge you to restore access to the Public Use Data File immediately and to update the file quarterly on its traditional schedule of within two months following the end of each calendar quarter.
If HRSA does not plan to promptly re-post the file on the NPDB’s website, please consider this letter to be a formal request by Public Citizen under § 427(b)(1) of the Health Care Quality Improvement Act of 1986 for a data file containing the same record categories, variables, and value categories as has traditionally been made available in the Public Use Data File. We would request that this data be made available for all records currently in the NPDB as submitted between the Data Bank’s opening and June 30, 2011. In addition, we would like the requested file to contain an assigned entity number (analogous to the practitioner number traditionally in the Public Use Data File), so we can analyze reporting patterns by various types of entities without, of course, naming specific physicians, health care entities, other health care practitioners, or patients.
Thank you for your attention to this important matter.
Michael A. Carome, M.D.
Public Citizen’s Health Research Group