Form non user survey non user survey non user survey

IVR

DRAFT THREE – MARCH 19, 2007

The Gallup Organization

PROJECT REGISTRATION #

HRSA – NPDB/HIPDB APPROVED BY CLIENT

City Center: Government

National Practitioner Data Bank

Non-User APPROVED BY PROJECT

Bogart/Steiger/Dean

Scott Cook, Programmer SURVEY DESIGN: Deb Brown

August 2007 n=

OMB No. 0915-XXXX

Expiration Date:

THE NATIONAL PRACTITIONER DATA BANK (NPDB)

AND

THE HEALTHCARE INTEGRITY AND PROTECTION DATA BANK (HIPDB)

NON-USER QUESTIONNAIRE

Sa. STRATUM: (CODE FROM SAMPLE FILE)

1. NPDB Non-User ONLY (No Current NPDB Registration)

2. HIPDB Non-User ONLY (No Current HIPDB Registration)

3. NPDB AND HIPDB Non-User (No Current NPDB AND HIPDB Registration)

(NOTE: NPDB non-users are defined as those entities that are eligible to register with the NPDB, but are not currently registered. HIPDB non-users are defined as those entities that are eligible to register with the HIPDB, but are not currently registered)

(If Sa=2, THEN SKIP to #3, ELSE CONTINUE)

1. Have you ever heard of the NPDB--National Practitioner Data Bank?

Article I.Yes

Article II.No

(If Sa=1 and CODE 2 in #1, SKIP TO #5)

(If Sa=3 and CODE 2 in #1, SKIP TO #3)

2. Is your entity currently registered to query and/or report to the NPDB?

1 Yes

2 No

(If Sa=1 AND CODE 1 IN #2, THANK AND TERMINATE)

(If Sa=1 AND CODE 2 IN #2, SKIP TO #5)

(If Sa=3 AND CODE 1 OR 2 IN #2, CONTINUE)

3. Have you ever heard of the HIPDB--Health Integrity and Protection Data Bank?

1. Yes

2. No

(If Sa=2 and CODE 2 in #3, SKIP TO #5)

(If Sa=3 and CODE 2 in #3, SKIP TO #5)

4. Is your entity currently registered to query and/or report to the HIPDB?

1. Yes

2. No

(If Sa=2 and Code 1 IN #4, THANK AND TERMINATE)

(If Sa=3 and Code 1 IN #2=1 and CODE 1 IN #4, THANK AND TERMINATE, ELSE CONTINUE)

5. Which of the following BEST describes your entity?

1 Hospital

2 Managed Care Organization

3 Group Practice

4 Other Provider of Health Services

5 State Licensing Board

6 Other Government Agency

7 Professional Society

8 Other Private Sector Entity

9 Other (Open Ended and Code)

(If Code 5 in #5, ASK #6 THEN ASK #9-1)

(If Code 7 in #5, ASK #7 and #7a THEN ASK #9-1)

(If Code 1,2,3,6, in #5, ASK #8 THEN ASK #9-1)

6. About how many practitioners does your State Licensing Board issue new or renewal licenses to each year? (Open Ended and Code Actual Number)

7. Does your professional society screen the credentials of some or all membership applicants or members?

1 Yes, all applicants or members are screened

2 Yes, some applicants or members are screened

3 No, no applicants or members are screened

(If code 1,2 in #7, CONTINUE)

(If code 3 in #7, THANK AND TERMINATE)

7a. If so, how many practitioners do you screen each year? (Open Ended and Code Actual Number)

8. How many practitioners does your entity credential each year? (Open Ended and Code Actual Number)

9-1. Please indicate which of the following sources of information, if any, you use in your licensing, credentialing, or application decision-making process?

1 Yes

2 No

a. ABMS (American Board of Medical Specialties)

b. AMA (American Medical Association)

c. BADB/FSMB (Board Action Data Bank, Federation of State Medical Boards)

d. HIPDB (IF CODE 2 in Sa, DO NOT ASK)

e. Hospitals

f. Licensing boards of your STATE

g. Licensing boards of other STATES

h. Medical schools

i. National entities of state licensing boards for non-physician practitioners, e.g., National Council of State Boards of Nursing (Nursys), The Federation of Chiropractic Licensing Boards (CIN-BAD), etc.

j. NPDB (IF CODE 1 in Sa, DO NOT ASK)

k. Practitioner’s currently affiliated Health Plans

l. Previously affiliated health plans

m. Practitioner’s current medical malpractice insurance carrier

n. Practitioner’s previous medical malpractice insurance carrier

o. Other health care entities

p. Professional Societies

q. Residency programs

r. Other Sources (Open-ended)

10. Do you contract with an outside agency to handle portions of the process used to gather information for applications, licensing, credentialing decision-making processes?

1 Yes

2 No

11-1. On a scale of 1 to 7, where 1 is not at all important, 7 is very important, and the other numbers represent something in between, how important are the following in your licensing, credentialing, or application decision making process?

1 Not at all important

2

3

4

5

6

7 Very Important

a. Multiple medical malpractice payments over a period of years

b. Single, large medical malpractice payment during a period of years

c. An adverse action resulting in a reduction of clinical privileges

d. An adverse action resulting in a suspension of clinical privileges

e. An adverse action resulting in a revocation of clinical privileges

f. A probation imposed by a State Licensing Board

g. A suspension imposed by a State Licensing Board

h. A revocation imposed by a State Licensing Board

i. Another action by a State Licensing Board

j. A probation of a membership in a professional society

k. A suspension of a membership in a professional society

l. A revocation of a membership in a professional society

m. Medicare or Medicaid exclusions

n. A criminal conviction

o. A civil judgment (non-malpractice)

(If Code 1,3 in Sa CONTINUE)

(If Code 2 in Sa SKIP TO #14)

12. Has your entity EVER queried the NPDB?

1. Yes

2. No

(If Code 2 in #12, SKIP TO #14)

13. When was the last time your entity queried the NPDB?

1. Less than one month ago

2. One to less than three months ago

3. Three to less than six months ago

4. Six months to less than one year ago

5. One to less than two years ago

6. Two to less than three years ago

7. Three to less than five years ago

8. Five or more years ago

9. Don’t Know

(If Code 2,3 in Sa CONTINUE)

(If Code 1 in Sa SKIP TO #16)

14. Has your entity EVER queried the HIPDB?

1 Yes

2 No

(If Code 2 in #14, SKIP TO #16)

15. When was the last time you queried the HIPDB?

1. Less than one month ago

2. One to less than three months ago

3. Three to less than six months ago

4. Six months to less than one year ago

5. One to less than two years ago

6. Two to less than three years ago

7. Three to less than five years ago

8. Five or more years ago

9. Don’t Know

(If sa=1 and CODE 2 in #2, ASK #16)

(If sa=3 and CODE 2 in #2, ASK #16)

ELSE SKIP TO NOTE BEFORE #18)

16. Why is your entity not currently registered to query and/or report to the NPDB? (Allow three responses)

1 Other (Open-Ended)

17. Is there anything the NPDB could do to increase the likelihood of your entity re-registering to query and/or report in the future? (Open-Ended) Allow three responses

1 Other (Open-Ended)

(If sa=2 and CODE 2 in #4, ASK #18)

(If sa=3 and CODE 2 in #4, ASK #18)

(ELSE SKIP TO FINISH)

18. Why is your entity currently not registered to query and/or report to the HIPDB? (Allow three responses)

1 Other (Open-Ended)

19. Is there anything HIPDB could do to increase the likelihood of your entity re-registering to query and/or report in the future? (Allow three responses)

1. Other (Open-Ended)

SURVEY FINISH

6

©The Gallup ORGANIZATION 02/05/21

NPDB/HIPDB NON-USER Survey