Payments for medical malpractice are reportable to the National Practitioner Data Bank (NPDB). Losing your medical license is reportable to the NPDB.
What about Performance Improvement Plans (PIP)? Are they reportable to the NPDB?
Let’s start with what a PIP is.
A performance improvement plan is a document that communicates with an employee their job-specific challenges as related to the expected result/performance outcomes, and what training and resources will be available to support the employee as they work towards improvement. The PIP also identifies potential consequences if improvement does not occur to the level indicated and/or within the timeframe provided. While this documentation will be helpful should termination result in the future, that is not the primary goal of a PIP. Instead, the intended outcome is employee development and performance improvement, as the name indicates.
In many bylaws, a PIP is explicitly labeled as “non-disciplinary.” This is helpful if you are scratching your head wondering if your PIP is disciplinary. If it is a non-disciplinary action, it is generally not reportable to the NPDB.
Still, the lawyerly answer as to whether a specific PIP is reportable to the NPDB depends upon what led to the action, and whether the action restricts your privileges.
The NPDB spells it out:
Imposition of a quality improvement plan [another phrase for “performance improvement plan.”] raises two issues with respect to reportability. First, a quality improvement plan may restrict a practitioner’s clinical privileges. If so, and if the restriction is the result of a professional review action, concerns the practitioner’s professional competence or conduct, and is in place longer than 30 days, the plan may be reportable.
Second, if the quality improvement plan does not meet these requirements, it nonetheless may be considered an investigation so long as it meets the other requirements for an investigation (for more information, see the Investigations section of the NPDB Guidebook.) The reporting entity needs to determine whether the quality improvement plan is focused on one practitioner for competency concerns and whether such plans typically lead to a professional review action. When making this determination, the entity should consider the language of the plan: Does it describe future disciplinary measures that may follow if the elements of the plan are not met? The entity also may consult its bylaws and policies, as well as standard practices, to decide whether the plan is the type of inquiry that leads to a professional review action. If the quality improvement plan meets the requirements of an investigation, then a resignation while under the plan would be reportable.
If the PIP merely notes what you are expected to do, then it likely is not disciplinary, and likely not reportable to the NPDB.
If the PIP notes what you cannot do – for example, a requirement you cannot take a patient to the operating room without the surgery chairman’s approval, that IS a restriction, and potentially reportable, if it lasts more than 30 days. Note, discussing the case with the surgery chairman after it is over is not generally a restriction, because you were not prevented from taking the patient to the OR. You just had to discuss the case after the fact.
And, even if you have to discuss cases with the surgery chairman before being allowed to post on the schedule, that is not reportable to the NPDB until that restriction lasts more than 30 days. So, if that imposition lasts for just 2 weeks, it’s not reportable.
OK, what if you resign while in the middle of a performance improvement plan?
If the PIP is considered an “investigation”, then, in theory, the hospital will need to file a NPDB report. Even if the PIP was only one day old.
How do you know if your PIP is considered an investigation?
You will need to look at the bylaws. If you are not 100% certain after eyeballing the bylaws, then just ask. If you are thinking about resigning, you do not want the resignation to be stained by a Data Bank report labeling you as having “resigned while under investigation.” It’s better to know precisely how your PIP has been characterized.
Most of the time PIPs are non-disciplinary. Most of the time PIPs are not considered investigations. But not always. Trust, but verify. In writing.
What do you think?
Great Post! Looking to write for Kevin MD and if you’re interested in collaborating let me know.
Good analysis by Jeff.
A few items to consider: Does the surgeon feel in his/her heart that this PIP is reasonable and genuine? What generated this PIP? Is it due to politics, economics, or a thousand other issues besides clinical competence?
And, considering how dangerous the act of “data banking” is, does the surgeon really thinks that this is a “do it yourself” job?
And, also consider the fact that many states do not consider medical staff bylaws to be a contract, and even if that is the law, the surgeon really has no leverage to assert his position.
Life is not fair, but, if one has an MD or DO attached to his name, one has even less rights than a criminal.
Richard Willner
The Center for Peer Review Justice
Regarding “investigations” as in, ” am I under investigation”? Well, in a perfect world, a doc who is under investigation will be notified. That is in a “perfect” world. What if the investigation has started and the doc is not notified? What if the doc is considered a “disruptive physician” and may not be notified?
And, what is a routine and normal investigation vs one that is really a serious “investigation”? No, these are not academic questions. These are questions that can really stop a career cold. Hard to believe that there is no substantive due process once one accepts the MD or DO diploma, right? This is the United States where there is a Constitution, right?
Friends, we all worry about medical malpractice. It is always in the back of our minds. But, may I submit that even if one is tagged with a medical liability claim, sure one will feel horrible for years, but, there is an insurance policy, objective judges, rules of evidence, objective professional experts and all proceedings are done under Civil law. And, physicians win about 90 percent of the time. And, it is rare for a doc to lose his privileges or license even after a proven medical malpractice. However, with a professional peer review which is a sham, where the laws and regs are gamed, the chances of getting timed out ( 30 days except in CA where it is 15 days) and then data banked is rather high. A negative data banking is permanent and can very well stop a career cold.
This is not legal advice but sad reality.
Richard Willner
The Center For Peer Review Justice
Since 2000.
It may be possible to mitigate the damage that being reported on the NPDB can cause. But any reasonable physician should recognize that mitigation is an unexpected long shot.
It was not constructed to be “repairable.” It was constructed to bring physicians to their knees and institute complete control over them.
The myriad malignant thicket of laws and regulations complete their circle of malevolence. Make no mistake (pun intended), WE permitted this to happen.
I frequently write about the necessity for physicians to plan financially for “forced retirement.” Fortunately, due to their relatively high earning capacity, this is feasible.
But the reverse side of the coin is that it is very difficult to emulate high earning without licensed patient contact.
The writing is on the wall. If you fail to plan for forced retirement, you have only yourself to blame.
Michael M. Rosenblatt, DPM