State Physician Profiles: Both a Minefield and Marketing Opportunity

This firm, in a series of articles[1], has made clear the importance of maintaining accurate information regarding physician profiles in the National Practitioner Data Bank (“the NPDB”), a database operated by the U.S. Department of Health and Human Services that contains adverse action reports on health care professionals. Also of importance is the accuracy of information contained in state physician profiles, which—unlike the NPDB where only authorized users can gain access—can be accessed online by all members of the public.

State physician profiles are meant as an online resource for consumers, patients, insurers, and the public at large. Generally, they will require that certain information be provided by the physician, such as the physician’s education, board certifications, participation in health plans, hospital privileges, and medical malpractice payments and other legal and adverse actions taken against the physician. Other information may be voluntary, such as publications in medical literature, academic appointments, and other information related to the physician’s practice. Within a certain, short period from the initial date of state licensure, physicians will be directed to complete their online profile, and updates at certain intervals will also be mandated. In addition, states will require change in profile information (updates) upon the happening of certain events, such as malpractice payments or limitations on hospital privileges and professional licensure. As the rules may vary state-to-state on mandatory information and timelines, it is important to know the requirements of your state’s physician profile. Professional discipline could be imposed if a physician knowingly provides materially inaccurate information, or otherwise fails to keep up with the “change in information” requirements. When in doubt, a potential remedy is to request an opinion through legal counsel of a physician’s reporting obligations under the laws and regulations of the state.

Given the increasing public use of the profiles by consumers, physicians should view the profiles as a marketing tool. Accurately providing and updating the profile with as much information as the state allows, should be a welcomed task. The problem is when adverse information is recorded and displayed on the profile, what can be done?

Again, the states differ in their approach. For example, New York allows for the filing of a “concise statement” in the profile to correct factual inaccuracies or to address adverse information. Regarding medical malpractice, New York requires public dissemination of all medical malpractice court judgments and arbitration awards in the most recent 10 years, any malpractice settlements which exceed two in number in the last ten years, and in cases where settlements are two or fewer, any case where the malpractice event resulted in death or permanent injury. It then allows for appeals of the notice to post a malpractice settlement, within 30 days of the date of the letter transmitting a physician’s medical practice review copy, to a panel appointed by the Department of Health. Such appeals allow for the submission by the physician of “additional factual clinical information pertinent to the department’s determination of whether settlement information is relevant to patient decision-making.” Contrast this to New Jersey, which only allows dissemination of medical practice actions within the most recent 5 years and allows 30 days for the physician to dispute to the New Jersey Board of Medical Examiners the accuracy of any proposed change to the information on the physician profile.

Do not take your physician profile lightly. On the positive side, it can be a valuable marketing tool as it can be accessed by the public. On the negative side, failure to keep it updated and accurate can result in professional discipline. If any adverse information is posted, it is important to check the accuracy, to file an explanation with mitigating circumstances when allowed, and to object to or appeal the information if public dissemination is not required or the no longer required (time limit has expired).

How Frier Levitt Can Help

Frier Levitt has extensive experience representing physicians and healthcare providers in a variety of matters, including mandatory reporting requirements to federal, state and accreditation authorities, as well as with representing physicians in the adverse actions that may trigger reporting requirements. Contact us to learn more about how to properly navigate and mitigate the impacts of mandatory reporting of change in information and adverse events.

 

[1] Read Frier Levitt’s Navigating the National Practitioner Data Bank (“NPDB) Series below:

Part I – Introduction to Reporting

Part II – Reportable Events & Queries

Part III – Healthcare Quality Improvement Act

Part IV – Subject Statements & Introduction to the Dispute Process

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