Network Insights – Do You Have the Right NPIs for Accurate Sunshine Act Reporting?
This year, the conclusion of the NCAA March Madness tournament is not the only anticipated event on the calendar. The life sciences industry has a buzzer beater of its own with the first round of data submissions due under the Physician Payments Sunshine Act.
Since the National Provider Identifier (NPI) is used to align individuals and organizations in the reporting process, the completeness of the database has an important bearing on the quality of the reports being submitted.
Life sciences companies should be wary, however, of using the NPI database as their only reference for reporting. Analyzing the data in the NPI registry, and comparing it with over 10 million HCP and HCO profiles in the Veeva Network Provider Database reveals duplicate data that may lead to reporting errors:
- 943,680 NPI numbers in the registry belong to doctors, representing roughly 96 percent of the MD/DO population
- Two percent of all HCPs have duplicated information, with more than one NPI number in the database
- 293,886 NPI numbers in the registry represent 62 percent of mid-level practitioners such as nurse practitioners and physician assistants
- Mid-level practitioner data shows a 15 percent duplication rate. Because mid-level practitioners are often more mobile than other providers, many may be creating a new NPI profile, instead of updating their existing ones, every time they move to a new organization
- The NPI registry shows 1,000,000+ NPI numbers associated with HCOs, but there are only ~860,000 patient facing-healthcare organizations. A hospital, for example, could have a NPI for the organization as the whole, another for the pharmacy, and another for physician services
Life sciences companies must reconcile such data issues in preparation for their report submissions. Improper and/or incorrect reconciliation of NPI numbers may cause missed or misstated spend information. Inaccurate reports introduce compliance risk, and may result in soured customer relationships.
Like March Madness, these reports will be an annual event, and life sciences companies will always need complete and up-to-date profiles, including the right NPI information. Identifying and aggregating HCPs and HCOs that have multiple NPI numbers will be key to maintaining accurate Sunshine Act reports.
Dharma Subramanian is the Director of Network Strategy.