2018 updates to the NPDB Guidebook



On October 26, 2018, the National Practitioner Databank (NPDB) released a third edition of the NPDB Guidebook. Among other changes, it updated Chapter E: Reports, Reporting Adverse Clinical Privileges Actions.

NPDB released a Policy Statement in 2017 foreshadowing these updates, seemingly in response to a 2017 federal court decision related to reportability of a proctoring arrangement. So, while these changes, previewed below, are not surprising, entities will want to understand the 2018 updates to the NPDB Guidebook to avoid HRSA scrutiny and to protect their statutory immunity.

Length of restriction

The 2018 update includes a new section, titled “Length of Restriction,” which clarifies that when a professional review action adversely affects the privileges of a practitioner for longer than 30 days, it is reportable, regardless of how the restriction order is written. The timer begins when the practitioner cannot practice the full scope of his or her privileges.

Proctoring example

In similar form, the 2018 proctoring section updates make it clear that when a proctoring arrangement that restricts a practitioner’s clinical privileges is in place as a result of a professional review action, and in fact lasts longer than 30 days, then the proctoring is reportable regardless of how the proctoring order is written. For example, if a proctor must be present for a practitioner to perform his or her next 10 surgeries, and no maximum length of time is included in the proctoring order, whether the proctoring is reportable will depend on whether it takes longer than 30 days for the 10 surgeries to take place.


Seven new Q&A subjects are outlined below.

Q. 22: Whether an agreement not to exercise privileges during an investigation that lasts longer than 30 days may be reportable.

Q. 23: Whether a leave of absence while under investigation that affects privileges may be reportable.

Q. 24: Whether the withdrawal of a reappointment application may be reportable if an inquiry is ongoing that deviates from routine review.

Q. 25: Whether a resignation while under a “quality improvement plan” may be reportable.

Q. 31: Whether requiring a surgeon to operate with a qualified first assistant may be a reportable event.

Q. 46: Whether the lapse of privileges at the end of a scheduled term, after a Medical Executive Committee’s recommendation to deny reappointment but before a hearing is held, may be reportable.

Q. 49: Whether an adverse clinical privileges action that is changed by a court order should be reported as a revision or a void. 

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