Why are we seeing so few provider discipline reports?
In a recent article for USA Today, Jayne O’Donnell reported on the dramatic reduction in administrative actions taken against providers’ licenses since the beginning of the COVID-19 pandemic. She wrote:
Emergency actions against doctors’ licenses dropped 59% from April through June of this year compared with the same period last year.
Emergency license suspensions and restrictions dropped 85% in April alone, according to the federal Health Resources and Services Administration, which administers the National Practitioner Data Bank. Keep reading at USA Today.
Reasons for Decreased License Disciplinary Actions
O’Donnell calls out several contributing factors to the reductions in disciplinary actions, including:
- State funding and layoffs at medical boards
- COVID-19 shutdowns
- Remote work challenges
- Physician shortages
- Decreased patient encounters
Fewer License Board Actions May Put Patients at Risk
Donna Thiel, ProviderTrust’s Chief Compliance Officer, said, “The alarming thing about this report, and O’Donnell calls this out, is the potential for patient harm during the substantial time delays we see from the initial complaint to the action taken against the license. We know that these time delays can result in the provider relocating and more patients being harmed by that provider. If the provider can make the jump to a new organization and pass at-hire screenings before the disciplinary action is published, they can often fly under the radar for a couple of years.”
Timeline of a Healthcare License Discipline
Here’s a real timeline of how long it took for a misconduct allegation against a provider to become a sanction, license revocation, and eventual OIG exclusion.
What this Means for Providers
Providers looking to ensure compliance and protect patients should be vigilant about screening for disciplinary actions on an ongoing basis. Given the increased possibility of bad acting caregivers flying under the radar at this time, providers would be wise to pay special attention to those involved in home health and telehealth encounters.
Our team has developed a Guide to Telehealth and Credentialing During COVID-19 to help provide some clarity on new exceptions and requirements for licensed providers. You can also follow along with state licensure updates with our COVID-19: License Portability Updates and State Medical Board Waivers page.
What this Means for Payers
Fewer board actions against licenses means credentialing and re-credentialing processes could return fewer eligibility issues in this area. But if state board backlogs result in license revocations for any recently (re)credentialed provider in your network, that issue could go unnoticed for years without ongoing license verification, triggering recoupment efforts.
Smarter Monitoring by ProviderTrust
This is why ProviderTrust’s smarter monitoring is the gold standard for detecting license and disciplinary issues as quickly as possible. Our enhanced data deliver exact-match alerts sooner than any other solution. Get the insight you need via your HRIS, Salesforce, or other data warehouse to improve operational efficiency, protect your organization, and keep patients and members safe.