OMB Number: 0915-0366; Expiration date: XX/XX/202X
Entities Survey: Module 13
Number of questions: 7
Perceptions of Practitioners with Reports in the NPDB
Q 13.1. What do you think are health care organizations’ perceptions of health care practitioners with any of the following reports in the NPDB? (Please select from the rating scale for each of the items.)
Rating Scale for Each Item
Neutral / Slightly Negative / Somewhat Negative / Moderately Negative / Extremely Negative
Medical Malpractice Payment
State Licensure Action
Clinical Privileges / Panel Membership Action
Health Plan Other Adjudicated Action (e.g., contract termination)
Professional Society Membership Action
Federal Licensure (including DEA)
Government Administrative Action
Federal or State Exclusion or Debarment
Private Accreditation / Peer Review Organization Action
Judgment or Conviction
Other (Please Explain) ____________
Survey Page Break
Q 13.2. How often does receiving the following kinds of reports from the NPDB impact on health care practitioners’ ability to obtain certification, licensing, credentialing, clinical privileges, or employment? (Please select from the rating scale for each of the items.)
Rating Scale for Each Item
All the Time
Most of the Time
More than Half the Time
About Half the Time
Less than Half the Time
Rarely
Never
Not Applicable (Please Explain) ________
Other (Please Explain) _________
Medical Malpractice Payment
State Licensure Action
Clinical Privileges / Panel Membership Action
Health Plan Other Adjudicated Action (e.g., contract termination)
Professional Society Membership Action
Federal Licensure (including DEA)
Government Administrative Action
Federal or State Exclusion or Debarment
Private Accreditation / Peer Review Organization Action
Judgment or Conviction
Other (Please Explain) ____________
Survey Page Break
Q 13.3. How does having a medical malpractice payment report in the NPDB impact a health care practitioners’ medical liability insurance?
No impact
Negative impact (increased premiums or hard to get insurance)
Do not know
Survey Page Break
Q 13.4. Please rate the impact on health care practitioners’ ability to obtain certification, licensing, credentialing, clinical privileges, or employment, if they have any of the following kinds of medical malpractice payment reports in the NPDB. (Please select from the rating scale for each of the items.)
Rating Scale for Each Item
Neutral / Slightly Negative / Somewhat Negative / Moderately Negative / Extremely Negative
Malpractice payment of $1 to $5,000
Malpractice payment of $5,001 to $10,000
Malpractice payment of $10,001 to $50,000
Malpractice payment of $50,001 to $100,000
Malpractice payment of $100,001 to $1,000,000
Malpractice payment of more than $1,000,000
Q 13.5. Please rate the impact on a health care practitioners’ ability to obtain certification, licensing, credentialing, clinical privileges, or employment, if they have 1 or more medical malpractice payment reports in the NPDB. (Please select from the rating scale for each of the items.)
Rating Scale For Each Item
Neutral / Slightly Negative / Somewhat Negative / Moderately Negative / Extremely Negative
1 report
2 reports
3 reports
4 reports
5 reports
More than 5 reports
Survey Page Break
Q 13.6. How likely it is that your organization will reject an application with any of the following reports in the NPDB?
Rating Scale for Each Item
Extremely unlikely / Unlikely / Neutral / Likely / Extremely likely
Medical Malpractice Payment
State Licensure Action
Clinical Privileges / Panel Membership Action
Health Plan Other Adjudicated Action (e.g., contract termination)
Professional Society Membership Action
Federal Licensure (including DEA)
Government Administrative Action
Federal or State Exclusion or Debarment
Private Accreditation / Peer Review Organization Action
Judgment or Conviction
Other (Please Explain) ____________
Survey Page Break
Q 13.7. How does having the following kinds of reports in the NPDB impact on health care practitioners’ ability to obtain certification, licensing, credentialing, clinical privileges, or employment above and beyond the impact of the original action that resulted in the report? That is, what kind of an impact an NPDB report has, not the action itself?
Rating Scale for Each Item
Neutral / Slightly Negative / Somewhat Negative / Moderately Negative / Extremely Negative
Medical Malpractice Payment
State Licensure Action
Clinical Privileges / Panel Membership Action
Health Plan Other Adjudicated Action (e.g., contract termination)
Professional Society Membership Action
Federal Licensure (including DEA)
Government Administrative Action
Federal or State Exclusion or Debarment
Private Accreditation / Peer Review Organization Action
Judgment or Conviction
Other (Please Explain) ____________
Piping Logic:
Survey will be directed to Module 14 next.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Microsoft User |
| File Modified | 0000-00-00 |
| File Created | 2021-02-15 |