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Health Care Quality
Improvement Act 1986
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| Major focus of
HCQIA
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A major piece of legislation
was passed in 1986 which relates to clinical quality management.
The Health Care Quality Improvement Act (HCQIA) addresses protection
from legal liability when professionals are involved in peer review
activities. With this act, doctors and nurses and other
healthcare professionals can participate in quality review
activities without fear of personally being sued (held liable) for
their review actions. Hospitals and other healthcare
institutions and providers can have active programs to look at
quality of care issues. The second
major section of HCQIA establishes the National Practitioner Data
Bank (NPDB). This federally sponsored database receives
reports about malpractice decisions, denial of medical staff
privileges and loss of medical license. Reporting is required
at multiple levels and by multiple organizations. |
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| The doctor can
run but he cannot hide
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Prior to establishment of the
National Practitioner Data Bank, physicians could readily move from
one state to another when they lost their license to practice
medicine, when they had major malpractice settlements, and when they
were asked to leave the medical staff of a particular community
hospital. With required reporting, all the information is now
logged into the NPDB and physician specific information is available
for review by authorized persons. Examples of data available
in the NPDB are:
- malpractice payments
- actions by state boards of medical
examiners
- actions by hospitals in changing or
denying privileges to perform specific patient care services
- actions of professional societies
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| Reporting is
required by law
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The law requires specific
organizations to report their findings and actions against specific
physicians. It also requires specific groups (namely
hospitals) to inquire what information is available in the NPDB
about a specific physician. Now when a physician applies for
medical staff membership and delineation of privileges to provide
specific clinical services to patients, that hospital must query the
NPDB and secure a report of the physician's past practice history.
This query must also be done during each renewal of medical staff
privileges (usually occurs every 2 years) and when the physician
requests a significant change of privileges.
Organizations are subject to a large
monetary fine if they do not report physician specific findings and
actions to the NPDB. Hospitals and other healthcare
organizations also lose peer review liability protection if they do
not check on a physician's record with the NPDB.
Initial reporting and inquiring processes
were time intensive. Today all reporting and queries are done
electronically.
The government plans to expand the scope of
the National Practitioner Data Bank. As its name implies, all
healthcare practitioner will be included in this major federal
information database.
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