Public health
Adverse action reports against optometrists: Perspectives from the National Practitioner Data Bank over 18 years

https://doi.org/10.1016/j.optm.2010.09.015Get rights and content

Abstract

Purpose

The aim of this analysis is to describe characteristics of National Provider Data Bank (NPDB) adverse action reports against optometrists.

Methods

NPDB public use files were analyzed for details of reported optometrist adverse actions from 1991 through 2008. Types of actions, basis for actions, and reporting source were identified, along with geographic and demographic data.

Results

Between 1991 and 2008, a total of 216 adverse actions against optometrists were recorded nationally. Exclusion from Medicare or another government program accounted for 92% of all reports; the remaining 8% were related to unfavorable privileging decisions. Most cases with identifiable explanations were the result of either defaults on student loans (55%) or charges of fraud and abuse (39%). Over two thirds of all reports originated in just 12 states, and 74% involved younger optometrists (age 30 to 49). Repeat offenses were reported for 38% of sanctioned optometrists.

Conclusion

NPDB reported adverse actions against optometrists are infrequent but most commonly involve exclusion from Medicare or similar government programs. Student loan default, particularly by younger optometrists, is the single most common cause, followed by allegations of fraud and abuse. Because this national database is permanently archived and widely used by licensing and credentialing bodies, optometrists should endeavor to be ethically responsible and strive to avoid behaviors that mandate such action reports.

Section snippets

Materials and methods

Public use data files were acquired from the NPDB in late 2009. These raw data files contain selected variables pertaining to medical malpractice payments for physicians, dentists, and other licensed health care professionals. In addition, a variety of information is included regarding adverse licensure, privileging, and professional society membership obtained by the agency. It similarly includes reports of Medicare and Medicaid exclusionary actions taken by the HHS Office of Inspector General

Results

Of all 216 encounter reports, 73% of optometrists were between the ages of 30 and 49, and 91% were between the ages of 30 and 59. The age distribution by NPDB decade groupings is outlined in Figure 1.

More than two thirds (68%) of all adverse action reports originated in just 12 states or United States territories (See Figure 2). In contrast, no reports originated from 15 states. No adverse actions were identified between 1991 and 1994. Between 1995 and 2008, the number of reports per year

Discussion

Although commonly considered a repository only of malpractice claim information, the NPDB similarly records adverse health care provider action reports from a variety of agencies. For optometrists, these entries are less common than malpractice payments (609 malpractice payments during the same period), but nonetheless notable.7

Professionalism and accountability are receiving ever-increasing interest in the health care community, and optometrists are not immune from this trend.8, 9, 10, 11, 12,

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    • Disclosure: The authors have no financial or other relationships that might lead to a conflict of interest.

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    Published by Elsevier U.S.A.