Dispute Resolution Sample Case File_Redacted.pdf

NPDB Dispute Resolution Sample

Case File

NPDB Title IV Clinical Privileges Report

Dispute Resolution Welcome Package

Dispute Resolution Information Sheet

Scope of the Dispute Resolution Process

1. The Dispute Resolution Process can Determine Only:

Whether a Report was submitted in accordance with NPDB reporting requirements, including the eligibility of the reporting entity to report the information to the NPDB, Whether the Report accurately depicts the action taken as reflected in the written record provided by the reporting entity, and/or

Whether the reporter’s basis for the action is reflected in the written record provided by the reported entity.

2. Disputes Regarding NPDB Reports:

The Division of Practitioner Data Bank1 (DPDB), the organization that manages the National Practitioner Data Bank, has no legal authority to provide an independent medical investigation concerning clinical issues specified in the Report. All disputes related to a correct or incorrect diagnosis and appropriate or inappropriate treatment by a practitioner must be resolved with the reporting entity.

The DPDB does not review documentation provided by organizations or individuals other than the reporting entity and the subject of the Report. No investigations, panel reviews, other reviews, or references provided by other organizations or independent practitioners can substitute for a valid written record provided by the reporting entity and the subject of the Report.

The DPDB does not examine how a reporting entity uses its bylaws, how practitioners are disciplined, or how they are afforded due process. All such concerns must be resolved between the subject of the Report and the reporting entity.

The DPDB does not examine whether the subject of a Report was informed of an ongoing investigation.

The DPDB does not examine civil rights issues such as discrimination or harassment in the work environment.

Late reporting does not constitute grounds for disputing a Report. Although eligible entities must report medical malpractice payments and other reportable actions to the

1 The regulations governing the NPDB give the Secretary of Health and Human Services the authority to review, at the request of the subject of a Report, the accuracy of NPDB Reports. This authority has been delegated by the Secretary to the Division of Practitioner Data Bank (DPDB) of the Health Resources and Services Administration.

NPDB Guidebook F-4 and F-5 (2018).

NPDB within 30 calendar days of the date the payment was made or the action was taken, an entity’s failure to submit a Report in a timely manner does not preclude the NPDB from collecting a Report beyond the 30-day time frame. Issues of timely reporting are handled through the NPDB’s compliance program.

A number of Federal entities are governed by a Memorandum of Understanding (MOU) that determines their reporting policies and procedures.

3. Issues Outside the Scope of Review and Within Scope of Review:

If it is determined that your request to engage the Dispute Resolution process involves only issues outside the scope of review, a decision to retain the Report will be entered, and a statement by the DPDB will be added to the Report. It will note the limited jurisdiction of the process and will explain that the issues you raised were “outside the scope of review.”

You may withdraw your request for review at any time before a decision is made in your case. However, once a decision letter has been signed, you are no longer permitted to withdraw your request for review, and the DPBD’s statement will be added to your Report.

If your case involves issues within the scope of the DPDB’s review, a full review of those issues will be conducted. Reports ultimately found to not meet NPDB reporting requirements will be removed (“voided”). Reports found to be properly filed and accurate will be retained. A statement will be added to the Report noting that the Report was reviewed and stating the DPDB’s findings. Reporting entities will be requested to correct Reports which are required to be retained but are found to be inaccurate under the guidelines discussed above.

Dispute Resolution Review Process

1. Review of Dispute Resolution Requests:

Requests for review are assigned and processed in the order in which they are received.

A Decision will be made as quickly as possible, consistent with a thorough and fair review. If additional information is needed, you and/or the entity that filed the Report will be contacted. All cases are decided in accordance with applicable law, regulation, and written policy guidance. Determination of fact is based solely on the written record available to the DPDB from the authorized reporting entity and the Report subject (as noted above, the DPDB does not review documentation provided by organizations or individuals other than the reporting entity and the subject of the Report.) The record includes the Report itself, and all correspondence and documents submitted to us by you and your legal counsel (if any). It also includes correspondence and documents submitted by the reporting entity and the entity’s legal counsel (if any). The DPDB does not hold hearings or gather information orally.

2. When a Correction Occurs:

If a reporting entity files a correction Report while your case is pending, you will receive a copy of the corrected Report. If the correction resolves the matter to your satisfaction, you need do nothing further. If you would like the review to continue, despite the correction, you must request a new Dispute Resolution of the corrected Report. The copy of the corrected Report will include instructions on how to request Dispute Resolution of the corrected Report via the Internet. If the reporting entity fails to make a requested correction, the DPDB will make necessary changes or explain the nature of the error as part of its statement.

3. Your Decision Letter:

When the review is complete, the DPDB will mail a copy of the decision letter to you, the reporting entity, and the attorneys representing you or the reporting entity. If your Report is removed, the DPDB will notify you, the reporting entity and any queriers who have received a copy of the Report in the past three years. If the Report is retained, the DPDB will give you the opportunity to submit a new subject statement for inclusion in the Report, along with the DPDB’s statement concerning the review and the decision. The DPDB will send the new version of the Report including your subject statement (if any) and the DPDB’s statement to you, the reporting entity, and all queriers who received a copy of the Report in the past three years.

4. Keeping You Informed:

Our policy is to keep all parties fully informed as a case is processed. We do not engage in ex parte discussions. You, the reporting entity, and its attorney will receive copies of any future correspondence involving the substance of the case. If you have notified us in writing that you have retained an attorney to act on your behalf, we also will send copies of future correspondence to your attorney. If you send correspondence to us in the future, please also send a copy of your correspondence to the reporting entity and its attorney, if any. The reporting entity and its attorney are also requested to send you copies of any correspondence they send to us.

We will not provide information about your case to anyone other than you, your attorney, the reporting entity, and its attorney. However, we will inform authorized queriers that the Report has been disputed and is under the Dispute Resolution process. Authorized queriers include only those who previously queried and received a copy of the Report or who may query and receive one while this matter is pending. No other information about the case will be provided to queriers until the review is completed.

You may log on to the Report Response Service (RRS) to view your Dispute Resolution status at any time through the NPDB website (www.npdb.hrsa.gov). You will need your Report DCN and password. If you need log in assistance, please contact the Customer Service Center at 1-800-767-6732. The Customer Service Center is available weekdays from 8:30 a.m. to 6:00 p.m. (5:30 p.m. Fridays) Eastern Time. The Customer Service Center is closed for all Federal holidays.

Contacting Us

If you have questions about the processing of your case, need to change your mailing address or email address, or want to withdraw your review request, you may write to us at the following address:

National Practitioner Data Bank c/o DPDB – Dispute Resolution 5600 Fishers Lane Mail Stop 11SWH03 Rockville, MD 20857

Email may be sent to report_review@npdb.hrsa.gov . Since email is not a secure method of communication, we cannot ensure the confidentiality of email while in transit. In any correspondence, please refer to the Document Control Number (DCN) of the Report in question. The DCN is found at the top of the box in the upper-right corner of all pages of the Report. Our Customer Service Center number is 1-800-767-6732, but we strongly discourage calls regarding ongoing dispute reviews because of our policy prohibiting ex parte discussions. Please understand we cannot discuss the facts or issues in your case by phone.

Practitioner Supporting Documentation

EXHIBIT 1

EXHIBIT 2

INDEPENDENT CONTRACTOR PROVIDER SERVICES AGREEMENT

This INDEPENDENT CONTRACTOR PROVIDER SERVICES AGREEMENT (the "Agreement") is effective (the “Effective Date”), by and between , [name and designation], whose primary address:

Address Line 1 Address Line 2 City State Zip

(“Provider" or “You”) and the parties listed on the signature page to this Agreement (collectively " Medical Group" or “Us”) (each a “Party” and collectively the “Parties”).

1. Engagement. hereby engages You as an independent contractor to facilitate cross-coverage medical consultations and provide healthcare services to patients via live streaming video, interactive telephone, and/or secure e-mail as outlined herein (the “Telehealth Services”), and You hereby accept such engagement upon the terms and conditions set forth herein.

2. Status of Provider. You are an independent contractor for the furnishing of the Telehealth Services contemplated by this Agreement and shall not be deemed to be an employee, agent, servant or joint venturer of . You shall perform the services contemplated by this Agreement in accordance with Your independent medical judgment. You shall not be eligible for any benefit programs of . You will receive an annual IRS form 1099 for the Telehealth Services rendered under this Agreement.

3. Time Devoted to Telehealth Services. The number and scheduling of hours for You to perform the Telehealth Services contemplated hereunder is to be made, on demand, initially, then by mutual agreement per a periodic schedule, subject to the guidelines set forth on Exhibit A, as implemented.

4. Term. The term of this Agreement shall be for one (1) year from the Effective Date, and shall automatically renew for additional one (1) year periods, unless sooner terminated as provided herein.

5. Termination. This Agreement may be terminated by either You or Us, with or without cause, upon sixty (60) days’ written notice, or immediately, upon material breach of this Agreement. Additionally, any clinical privileges to treat patients are coterminous with any termination of this Agreement and any termination of clinical privileges pursuant to this provision is not subject to any hearing or appeals rights or procedures provided in or its designees policies and procedures.

6. Duties and Responsibilities of Provider. You shall have the following duties and responsibilities, all of which are material to this Agreement:

A. Render the Telehealth Services in a positive, cooperative, pleasant manner at all times, pursuant to policies and procedures, and in conjunction with the policies and procedures of or its designee’s management and billing companies. All Telehealth Services shall be provided by You in accordance with applicable standards of care. You warrant and represent that You are and will be at all times licensed/certified to practice medicine in all states in which You will provide the Telehealth Services, and that You are experienced, competent and physically and mentally able at all times to provide the Telehealth Services required under this Agreement and in the use of medical equipment, facilities and procedures required under this Agreement.

MD/2020

B. Apply for and maintain at all pertinent times such current licenses, credentials, accreditations, enrollments, and certifications (including health plan credentialing) as may be requested by Us from time to time.

C. Timely and accurately complete and/or return: (i) patient medical records, including handwritten notes, electronic medical record system, dictation (complete records of any patient encounter shall be returned within 24 hours of the encounter); (ii) requested credentials and applications, including third-party payer enrollment and billing applications and forms; and (iii) any other documentation or forms requested by Us, our management group, or our clients as necessary for You to provide services under this Agreement.

D. You will also perform the following in accordance with Policies and Procedures:

i. Validate patient identity and geographic location at the time of consultation and provide verification of Your credentials to each patient before providing any Telehealth Services;

ii. Ensure appropriate electronic recordation of all patient encounters and verification of patient identity and/or data/information based through the system;

iii. If at any time during a consultation, You determine in Your clinical judgment that the patient requires physical intervention, You will recommend to the patient that he/she be seen by a physician in-person, or be referred to a specialist. You will document this determination and advise the patient that (1) he/she cannot be treated via telephone or video, and (2) advise the patient as to what type of medical treatment the patient should seek elsewhere;

iv. In the event that You determine that a patient is in need of emergency medical care at any time during a consultation, You will take such steps as are necessary to ensure that the patient is referred to an emergency department for screening, stabilization, and treatment of the emergency medical condition;

v. Provider will not solicit a physician/patient relationship with any patient outside of the Platform. Nothing in this

Agreement will prevent Provider from evaluating, treating, or otherwise rendering care to any patient who presents at any hospital, urgent care center, emergency department, clinic, medical practice, or organization where Provider is engaged to provide healthcare services.; and

vi. When prescribing medication to a patient via Telehealth Services, You will comply with the requirements of the Rules of Your Board of Medicine (including electronic transmission of prescriptions), where licensed. Under no circumstances are You to prescribe narcotics or controlled substances.

E. You agree to comply with the representations and warranties and other requirements set forth in the Provider Certification Form, as may be amended from time to time, which is attached hereto as Exhibit B and incorporated herein by reference as part of this Agreement.

F. You shall perform such other lawful activities as may be requested by Us, our designees, or our clients from time to time that are necessary for the performance of under agreement(s) with clients.

G. Physician shall, during the term of this Agreement, provide prompt and professional medical attention to patients irrespective of age, sex, race, religion, disability, color, national origin, or any other status protected by applicable law. Such treatment shall be consistent with the facilities, personnel and equipment available and in conformity with the prevailing professional standard of care in the community.

7. Exercise of Independent Professional Judgment. You will exercise independent professional judgment in the treatment and care of patients, and in this regard will have complete control over decisions requiring medical judgment. You will be solely responsible for the medical care of patients. The provisions of the Agreement will not be deemed to affect the physician-patient relationship and the confidentiality thereof.

8. Payment to Provider. , or its designee, shall pay You as set forth in Exhibit A, as may be amended from time to time. As our primary concern is the highest quality of care, and recognizing the financial hardship poor record documentation imposes on the parties, Any Telehealth Services consultation lasting less than two minutes will not be paid. Medical records must be completed within 24 hours of the Telehealth Services consultation. If the medical record for a Telehealth Services Consultation are completed after seven days, You will be paid at 50% of the contracted rate. If the medical records are not completed within thirty (30) days of the date You provided the Telehealth Services consultation, the consultation will not be paid. You fully and voluntarily acknowledge and agree that may withhold payment for failure of You to timely and/or completely finalize and return any requested documentation or records.

9. Interference with Contractual Relations. You agree not to interfere with the contractual relationship between Us and any of our clients, or prospective clients to whom we have submitted a proposal for Telehealth Services, during the term of this Agreement, without our prior written approval. reserves all rights for equitable remedies or damages to enforce this provision for any violation thereof.

10. Professional Liability Insurance. provides claims-made professional medical malpractice coverage for Physicians that works on behalf of (s).

This coverage applies to every completed telemedicine encounter in amounts of per Claim and in the Aggregate, unless other limits are statutorily required by the state, in which case complies with all state requirements as to limits. Should a physician no longer provide professional services for , coverage will be automatically afforded for any future claims that result from medical incidents arising out of and related to medical care and treatment while you were providing professional services on behalf of this Agreement, subject to the terms and conditions of the applicable policies of insurance. There is no additional charge for this coverage.

11. Power of Attorney, Proxy and Assignment of Fees. You hereby appoint Us (and/or our authorized employees, agents, representatives or assigns) as attorney-in-fact with full power of substitution and delegation, to execute, bill for and to receive monies or endorse checks due or payable to You from any patient or third party payer by reason of medical professional or other services rendered by You pursuant to this Agreement. You shall not bill any patient, and third party payer, or any other responsible party for the services You provide for .

The powers of attorney and proxy granted above have been granted to secure performance of Your obligations under this Agreement and such powers may not be revoked, terminated or modified by You, and such powers shall remain in full force and effect until all terms and conditions of this Agreement and all insurance claims and fee billing issues have been completed and resolved to satisfaction of Us.

12. Confidentiality. During the term of this Agreement, You may become privy to or aware of proprietary or confidential information of , including, but not limited to, information relating to patients and the pricing of services, supplies and equipment. You: (A) will maintain in confidence all such proprietary or confidential information, including, without limitation, patient confidential information as required by HIPAA/HITECH, applicable state law or by our clients; (B) will not disclose such proprietary or confidential information to any third parties, except with prior written consent or to the extent required by law, and (C) will not use such proprietary and confidential information for any other purposes other than those of this Agreement.

13. Taxes, Worker's Compensation, Health or Disability Coverage/Indemnity. You agree, as an independent contractor, to be fully and completely responsible for appropriate self-employment tax payments, social security, worker's compensation, health or disability insurance, unemployment compensation, and any other tax or insurance payments as may be required by law. You agree to indemnify, defend and hold harmless for any action, claim, administrative investigation or hearing, including, without limitation, all damages, assessments, back taxes, costs, or expenses (including actual and reasonable attorney fees), arising out of or relating to any challenge to Your status as an independent contractor.

14. Peer Review. You agree (a) that any and all information and documentation regarding Your clinical competence or professional conduct that may be obtained or produced as part of the credentialing, quality assessment, or review of professional conduct by

, either or affiliates (“Affiliates”) or any clients who have delegated credentialing to either or (“Delegating Clients”) (collectively "Confidential Information") may be shared between

, Affiliates and such Delegating Clients. Such Confidential Information shall not include discussions by a peer review body, though it may include any decisions made by such a body that have been communicated to You; and (b) to extend absolute immunity to, release from any and all liability, and not sue or Affiliates disclosing Confidential Information (the "Disclosing Entity"), for disclosing information in good faith to the Delegating Clients, and/or for any action that may be taken by the Delegating Clients receiving the Confidential Information (the "Receiving Entity") from the Disclosing Entity. Additionally, You agree that if suit is filed in violation of this provision, You shall be responsible for and/or Affiliates’ attorneys’ fees and costs to defend such suit. For purposes of this paragraph, the Disclosing Entity and the Receiving Entity includes

, Affiliates and the Delegating Clients, and all of the employees, agents, and representatives of these entities.

15. Medical Records. All medical records shall be the property of and shall be responsible for the maintenance of medical records.

may provide You with access to the medical records of patients treated by You promptly after receipt of a reasonable written request.

For and on behalf of the above-named medical group parties

Date Signed

PROVIDER:

Signature Date Signed

Printed Name Email Address

Address Line 1 Address Line 2 City State Zip Physical Address

/2020

/2020

, MD

n

ADDENDUM B

PROVIDER CERTIFICATION FORM

PROVIDER REPRESENTATIONS AND WARRANTIES:

i. You are duly licensed to practice medicine and are in good standing in the State(s) in which You will offer the Telehealth Services and will maintain all required certifications and licenses during the term of this Agreement. You, at Your expense, will comply with all local, state, and federal laws and certifications by governing boards regarding certifications, business permits and licenses that may be required to carry out and perform the Telehealth Services specified in this Agreement.

ii. Your hospital-based privileges or medical staff membership(s), if any, have never been suspended, curtailed or revoked.

iii. You have, or will have prior to rendering direct patient care activities, and will maintain during the term of this Agreement, all credentials necessary for You to perform the Telehealth Services. To become credentialed to treat patients, in addition to other requirements, You must have and disclose to or its designee an active provider number, a current profile/information and must authorize, link or provide access to or its designee to Your active provider number and current profile/information.

iv. You must disclose to or its designee any pending or threatened malpractice claims, and any malpractice judgments or settlements, license or medical staff privilege investigations, or threatened license or medical staff disciplinary actions.

v. You must disclose to or its designee if You have been the subject of, suffered an adverse action by, or had hospital-based privileges suspended, terminated or limited by any local, state or federal professional licensing, credentialing or accreditation agency or board or any third party payer, including, without limitation, Medicare or Medicaid.

vi. You are not listed, and represent and warrant that You have no current reason to believe that during this Agreement that You will be so listed: (i) by a federal agency as excluded, disbarred, suspended, or otherwise ineligible to participate in Federal programs, including Medicare or Medicaid (this includes the Department of Health and Human Services Office of Inspector General’s List of Excluded Persons/Entities); or (ii) on the General Services Administration List of Parties Excluded from the Federal Procurement and Non-Procurement Programs.

vii. You warrant and represent that You will adhere to all guidelines, standards, rules, regulations, and policies of the Licensing Board of Your State of Licensure, the Board of Medical Specialties, the American Medical Association, and Medicaid/Medicare.

viii. Notwithstanding any due diligence performed by Us with respect to the subject matter of the herein representations, You shall indemnify and hold Us, our directors and officers, and agents and employees, harmless from any and all claims, causes of action, losses, damage, liabilities, costs and expenses, including attorney fees, arising from breach of the representations set forth in this Provider Certification Form.

ix. You will have the obligation to immediately disclose to Us, or our designee, any actions brought against You for negligence and malpractice or alleged negligence and malpractice threatened actions related to the services provided as a result of this agreement. You may defend and/or settle these matters only with full disclosure to Us prior to finalizing the matter. Should be a named party to any legal action of which You are a named party, You shall immediately disclose to said action.

x. You will from time to time be required to execute supplemental agreements, records and other documents. Upon request, You agree to execute same within ten (10) business days from the presentation of said documentation to You.

xi. Although the majority of all prescriptions created will be sent electronically, there are instances where a physical prescription will be necessitated, You may from time to time have to write hard copy prescriptions and, in that instance, You will be responsible for having Your own prescription pads created with Your licensing credentials that adhere to Your State’s licensing policies and regulations.

xii. You warrant that, without the express written consent of Us, You shall have no apparent or implied authority to: (a) Pledge the credit of or any of its other employees; (b) Bind Us under any contract, agreement, note, mortgage, or otherwise; (c) Release or discharge any debt due to Us. (d) Sell, mortgage, transfer, or otherwise dispose of any assets of

xiii. You will: (a) be cooperative and maintain a positive attitude towards Your patients, personnel, its management company and its personnel, and (b) maintain a professional appearance at all times while treating patients, including, without limitation, wearing a coat and tie and/or a lab coat.

xiv. You will complete the application fully and to the best of Your knowledge, to include the required items set forth below, which are attached hereto and incorporated herein by this reference.

IN ADDITION TO THE MATERIAL PROVISIONS OF THE AGREEMENT, YOU UNDERSTAND AND AGREE THAT

A MATERIAL BREACH WILL INCLUDE, WITHOUT LIMITATION, THE FOLLOWING:

xv. Use of alcohol or other substances to the extent that it impairs Your job performance or the ability to carry out obligations under this Agreement, or during working hours;

xvi. Unlawful prescription to patients of narcotics or controlled substances or use of illegal drugs;

xvii. Any arrest for or conviction of any offense punishable as a felony or any offense involving moral turpitude;

xviii. Any plea or finding of unprofessional or unethical conduct by any board, institution, organization or professional society having any privilege or right to pass judgment upon the conduct of Provider;

xix. The suspension, revocation, cancellation, or other restriction of Your license to practice medicine in the State or States where You are licensed or Your registration to dispense or prescribe any medications, or You otherwise becoming the target of, suffering an adverse action by, or having privileges suspended, terminated or limited by any local, state or federal professional licensing, credentialing or accreditation agency or board, hospital or other licensed facility, or any third party payor, including, without limitation, Medicare or Medicaid;

EXHIBIT 3

EXHIBIT 3

EXHIBIT 5

EXHIBIT 7

NPDB Request for Information

Reporting Entity Response with Supporting Documenation

, Dispute Resolution Manager National Practitioner Data Bank

CONFIDENTIAL AND FOIA EXEMPT

participating provider. Near the end of this meeting Dr. advised that he would like to resign. Within an hour of the meeting, Dr. submitted an email with his resignation from on that same day, .10

2. Investigation Reports, Meeting Minutes, and Supporting Documentation, Including Additional Correspondence with Dr.

The foregoing is outlined in Correspondence to Dr.

counsel. As requested, is submitting additional documentation, including correspondence with Dr. to further support the timeline and facts outlined in Section I and Section II(1) above, in response to your , 2023 letter.

1. Investigation Reports

As noted above, Dr. was under investigation and subject to a CAP at the time of his resignation. The investigation was being conducted by leadership of the Patient Safety Committee. Consistent with established practices and processes, the Patient Safety Committee evaluates telehealth consultations to review matters concerning or relating to the quality of medical care delivered to patients and to advance adherence to patient safety guidelines. The Patient Safety Committee may recommend continued provider monitoring, reeducation, or suspension or termination. The Patient Safety Committee monitored Dr. starting in at least

2021 and Patient Safety Committee meeting minutes for 2022 (see Appendix B) document the Patient Safety Committee’s actions to prepare a formal Corrective Action Plan for Dr. Then, on 2022, the Patient Safety Committee’s meeting minutes further

10 The 2023 letter indicates that Dr. counsel posits that this , 2022 meeting constituted an employment termination and thus would not have been reportable to the NPDB. We respectfully disagree.

NPDB Guidebook, Section E, Q&A Reporting Clinical Privileges Actions, #2, discusses whether an employment termination, as opposed to a system of professional review, would trigger a reporting requirement. If a termination was not a result of a professional review action, these Q&As suggest it would not be reportable. “It does not matter that the employment termination, which was a result of the hospital’s employment termination process automatically resulted in the end of the practitioner’s clinical privileges.”

However, the very next sentence states: “if the hospital had performed a professional review of the practitioner’s clinical privileges and revoked the practitioner’s privileges as a result of the review, the professional review action would have been reportable, even if the action started as an employment termination.” (emphasis added). Again, believes that the formal CAP presentation, training and continued review constitute professional review for the Report. See also n.4, supra.

As a result, even if in the scenario where the final employment action was a termination with formal privileges revoked rather than a resignation, the professional review action would still have been reportable.

CONFIDENTIAL AND FOIA EXEMPT

SUBMITTED VIA NATIONAL PRACTITIONER DATA BANK ONLINE SYSTEM

Dispute Resolution Manager National Practitioner Data Bank

Re: Response to 2023 Correspondence

Dear Mr.

Please see the attached response to your 2023 letter.

timely submits this correspondence and reserves the right to supplement its submission in light of any additional information submitted by Dr. remains available to answer any further questions during the National Practitioner Data Bank’s review.

Very truly yours, All Reports for: M.D.

DCN DBID Rcvd Date Report Type Status Title IV 1921 1128E

2022 AAR Initial Active Y N N 2019 AAR Initial Active N Y N

DCN is elevated for Dispute Resolution.

Private and Confidential. © Page 4

Review of MD #

Total Encounters

Median Duration

Consults

< 3m

Survey Return

(xRX Issues)

Avg.

Provider

Star Rating

Rx Rate Antibiotic Rate

Steroid Rate Polypharmacy

% Rx Sent within 60m

Hedis - Adult

Bronchitis

Hedis - Adult

Bronchitis Score

Continuity of Care

3 Day Return

Rate

% Consults with

Video Per Hour

Previous Month 1,269 3.2 43.80% 30 4.1 90.10% 47.00% 11.50% 22.06% 99.20% 50 6.00% 0.00% 3.50% 31.70% 8.3

Previous Quarter ) 4,311 3.9 33.10% 182 4.2 89.30% 50.80% 16.30% 18.19% 99.20% 217 28.60% 0.00% 3.10% 52.20% 7.5

Previous Year 9,564 3.6 36.50% 338 4.3 90.70% 48.20% 15.80% 20.16% 99.20% 458 53.30% 0.00% 3.90% 45.30% 4.8

Last 3 years YTD 16,831 3.6 36.50% 600 4.2 90.10% 48.60% 15.10% 19.77% 99.20% 792 39.10% 0.00% 3.60% 45.20% 5.6

KPI Data Metric Performance

Standard Score

(last 6 months) Score (last 30 days) Platform

Average Performance

Patients per hour - 8.2 7.3 4

Median Duration per visit (minutes) - 3.7 3.7 7.5

% Consults < 3 mins. <10% 36.6% 35.6% 5.0%

Avg. Provider Star Rating ≥4.4 4.2 4.3 4.4

Rx Rate - 89.4% 90.1% 73.3%

Antibiotic Rate - 49.9% 49.4% 40.7%

Steroid Rate <14% 14.6% 15.1% 11.0%

HEDIS Adult Bronchitis Score >38% 18.9% 33.9% 58.4%

Polypharmacy <6% 19.74% 20.12% 5.68%

NPDB Decision Letter