6 Demographics - State licensing certification

6 Demographics - State licensing certification.docx

Survey of Eligible Users of the National Practitioner Databank

6 Demographics - State licensing certification

OMB: 0915-0366

Document [docx]
Download: docx | pdf

OMB Number: 0915-0366; Expiration date: XX/XX/202X


Entities Survey: Module 6

Number of questions: 16



This module is relevant for the following entity identified in Module 2:

State Licensing Board, State Certification Authority and Federal Licensing Agency



Demographics Related Questions


Q 6.1. For the typical year, how many applications (new and renewals) for licensure or certification does your organization receive?


Select a number: __________

Do not know (Please Explain) ________


Q 6.2. For the typical year, how many applications (new and renewals) does your organization approve for licensure or certification?


Select a number: __________

Do not know (Please Explain) ________


Q 6.3. How many total staff members within your organization are responsible for licensing or certifying practitioners?


Select a number: __________

Do not know (Please Explain) ________


Q 6.4. How often does your organization review the records of practitioners for which your organization has granted licensure or certification?


Once every 6 months

Once per year

Once every 2 years

Once every 3 years

Once every 4 or more years

Ongoing

Other (Please Explain) _________


Q 6.5. Which of the following sources does your organization utilize for granting licensure or certification to a practitioner? (Please select all that apply.)


National Practitioner Data Bank (NPDB)

Practitioner’s Self-­Queries of the NPDB

Board Action Data Bank of the Federation of State Medical Boards (FSMB) or other national organization(s) of state licensing boards for non-physician practitioners

Licensing board(s) in your state

Licensing board(s) in another state

Practitioner’s current medical malpractice/liability insurance carrier(s)

Practitioner’s previous medical malpractice/liability insurance carrier(s)

Practitioner’s current affiliated health plan(s)

Practitioner’s previous affiliated health plan(s)

Other health care entities (other hospitals, HMOs, group practice, etc.)

Professional society(ies) (e.g., AMA, AOA, ANA, etc.).

Medical school(s) or other professional school(s)

Residency program(s)

Speciality certification organizations (e.g., ABMS)

OIG exclusion list

Drug Enforcement Agency exclusion list

Peer or professional references

Other (Please Explain) ____________


Survey Page Break


Q 6.6. What types of adverse licensure or certification actions does your organization take regarding practitioners? (Select all that apply.)


Revocation of License or Certification

Probation of License or Certification

Suspension of License or Certification

Summary or Emergency Limitation or Restriction on License or Certification

Summary or Emergency Suspension of License or Certification

Reprimand or Censure

Voluntary Surrender of License

Voluntary Limitation or Restriction on License

Limitation or Restriction on License or Certification

Denial of License or Certification Renewal

Denial of Initial License or Certification

Interim Action – Voluntary Agreement to Refrain from Practice or to Suspend License or Certification Pending Completion of an Investigation

Cease and Desist

Withdrawal of Renewal Application While Under Investigation

Publicly Available Fine/Monetary Penalty

Prescriptive/Dispensing Authority Action – Not Classified (Please Specify) _____

Publicly Available Negative Action or Finding (Please Specify) ________

Other Licensure or Certification Action – Not Classified (Please Specify) _____________


Q 6.7. For the typical year, how many times does your organization take disciplinary actions regarding practitioners?


None

1 to 5 times

5 to 24 times

25 to 49 times

50 to 99 times

100 or more times

Do not know (Please Explain)


Q 6.8. Has your organization ever been found to be non-compliant with the NPDB reporting requirements?


Yes

No skip the next question

Do not know skip the next question


Q 6.9. Please rate your organization’s level of satisfaction with the NPDB’s efforts to promote your organizations’ compliance?


Very Satisfied

Satisfied

Neither Satisfied Nor Dissatisfied

Dissatisfied

Very Dissatisfied


Survey Page Break


Q 6.10. Is your organization a state medical board?


Yes

No


Q 6.11. Does your organization receive clinical privileges action reports from the NPDB’s report forwarding service?


Yes

No

Not Applicable

Other (Please Explain) ________


If “yes,” go to the next question. Otherwise, skip to Q 6.13.


Q 6.12. How would you rate your level of satisfaction with the NPDB’s report forwarding service for clinical privileges actions?


Very Satisfied

Satisfied

Neither Satisfied Nor Dissatisfied

Dissatisfied

Very Dissatisfied


Q 6.13. Does your state medical board receive medical malpractice payment reports from the NPDB’s reporting forwarding service?


Yes

No

Not Applicable

Other (Please Explain) ________


If “yes,” go to the next question. Otherwise, end this module.


Q 6.14. How would you rate your level of satisfaction with the NPDB’s report forwarding service for medical malpractice payment reports?


Very Satisfied

Satisfied

Neither Satisfied Nor Dissatisfied

Dissatisfied

Very Dissatisfied


Survey Page Break


Q 6.15. Does your state medical board have a monetary penalty for hospitals for not reporting clinical privileges actions to the state medical board?


Yes

No Skip to the end of the module.

Not Applicable (Please Explain) ______________ Skip to the end of the module.


Q 6.16. Please provide the details of the monetary penalty.

Textbox



Piping Logic:


Survey will be directed to Module 8 next.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMicrosoft User
File Modified0000-00-00
File Created2021-02-15

© 2024 OMB.report | Privacy Policy