CPMSM- HCQIA (Healthcare Quality Improvement Act) and NPDB (National Practitioner Databank). 2023/2024 updated to pass

CPMSM- HCQIA (Healthcare Quality Improvement Act) and NPDB (National Practitioner Databank)What does HCQIA stand for? - correct answer Health Care Quality Improvement Act When was HCQIA enacted by congress? - correct answer 1986 What is the purpose of HCQIA? - correct answer HCQIA was enacted to created a national tracking system of physicians with a history of medical malpractice payments or adverse actions. What system was developed as a result of HCQIA? - correct answer The National Practitioner Databank (NPDB) What does HCQIA protect? - correct answer The review of physicians and dentists. The review of allied health professionals is NOT protected by the HCQIA. HCQIA of 1986 statute was enacted as a result of what case? - correct answer Patrick vs. Burgett: a federal antitrust case in which physicians were held liable for damages caused to Dr. Patrick by abusive and inappropriate peer review. In order to qualify for HCQIA standards of immunity a good faith peer review must what? - correct answer 1. Be carried out with the reasonable belief that the action was taken to further quality healthcare 2. Follow a reasonable effort, through investigation and review, to obtain the facts 3. Meet adequate notice and fair hearing procedures afforded to the physician or dentist, either by proving in court that the procedure was fair or by meeting fair hearing standards listed in the HCQIA (see below) 4. Have been conducted in the reasonable belief that the action was warranted by the facts after #2 (fact-finding) and #3 (fair hearing) are accomplished. Who is HCQIA community coverage available to? - correct answer 1. Professional review bodies - Medical staffs are examples of professional review bodies. 2. Members and/or staff of those bodies - The individual members and medical staff coordinators and credentialing specialists should qualify for protection under this section. 3. Those under contract with the bodies - Peer review consultants contracting to provide impartial review should be protected under this section. 4. Anyone who participates or assists the bodies with respect to action. 5. Those who provide information regarding competence/conduct unless the information is false and the person giving the information knew it was false. Whistle blowers are protected under this section. What are the exceptions to HCQIA immunity coverage? - correct answer 1. Healthcare entities failing to meet the standards for immunity. 2. Healthcare entities failing to report information to the National Practitioner Data Bank. The federal Health and Human Services Department would determine whether a hospital or healthcare entity failed to report as required, and could take away the immunity protection for up to three years.