10 Individuals - Perceptions

10 Individuals - Perceptions.docx

Survey of Eligible Users of the National Practitioner Databank

10 Individuals - Perceptions

OMB: 0915-0366

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


Self-Queriers Survey: Module 10

Number of questions: 7



Report in the NPDB


Q 10.1. 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 10.2. How often does receiving the following kinds of reports from the NPDB impact a health care practitioner’s 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 10.3. How does having a medical malpractice payment report in the NPDB impact a health care practitioner’s medical liability insurance?


No impact

Negative impact (increased premiums or hard to get insurance)

Do not know


Survey Page Break


Q 10.4. Please rate the impact on a health care practitioner’s 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 10.5. Please rate the impact on a health care practitioner’s 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 10.6. How likely it is that health care organizations 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 10.7. How does having the following kinds of reports in the NPDB impact on a health care practitioner’s 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 11.



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