Consumer Protection Rating: How the ELDD can Protect the Public

The ELDD is a comprehensive physical therapy database of disciplinary, licensure, and examination score information. The information stored in this database helps jurisdictions in multiple ways. This article is based on a 2022 Annual Education Meeting presentation by Charles Harvey, Corie Tillman Wolf, and Jason Kaiser.

Protecting the public is the purview of occupational licensing boards. As licensing boards, we each have a mission to protect the public from incompetent or unethical practitioners. Boards achieve that aspiration best when we collaborate. To ensure public protection, we need to know what licensees are doing both inside and outside of our own jurisdiction.

This is where the Exam, Licensure, and Disciplinary, Database, or ELDD, comes in. The ELDD is a comprehensive repository of data from exam registrations, PT Compact purchases, and licensee data provided directly from jurisdictional databases. The objective of the ELDD is to support the shared mission of public protection by maintaining a physical therapy database that facilitates data sharing among jurisdictions.

However, the effectiveness of the database is completely up to the FSBPT member boards. The ELDD captures, aggregates, and shares examination, licensure, and disciplinary data from and between member boards across state lines. But the data is only as good as the systems, methods, and frequency of each board's data updates.

The ELDD serves as an alert mechanism, similar to a check engine light on your dashboard. While the check engine light irritates most drivers, it gives you essential information about your car and should not be ignored. Along similar lines, the ELDD provides critical information about applicants at the time boards evaluate them for licensure. Boards are also alerted to sanctioned licenses and disciplinary actions other boards are finalizing against one of their licensees in other jurisdictions. Again, this prevents sanctioned individuals from moving across state lines to avoid the effects of disciplinary action, and it is critical to public protection.

Within the ELDD, the various data sources coalesce under individual licensees using their unique identification numbers. The ELDD provides proactive notifications to inform boards of licensure and compact privilege approval, as well as notification that one of their licensees has been disciplined in another state. Therefore, as a licensee moves from jurisdiction to jurisdiction, they cannot outrun discipline.

Here is what the ELDD needs from you, the FSBPT member boards, to help protect the public.

• Licensure data – containing each licensee's unique FSBPT ID
• Timely disciplinary data
• And that is it!

FSBPT ID

The first data set is the unique ID—a unique identification number is assigned to each licensee by the FSBPT, and this is how the ELDD identifies unique records. Many of our licensees, including those who have been disciplined, hold licenses in more than one state. The FSBPT ID enables the tracking of licensees who hold multiple state licenses, even as their name or geographic information changes. This helps prevent them from changing jurisdictions undetected.

Historically, FSBPT used Social Security Numbers as the unique identifier, but this presented a barrier for member boards that had concerns with sharing this information. Therefore, FSBPT shifted to using the FSBPT ID to reduce the use of personal protected information.

As of October 1, 2022, twenty-two boards share FSBPT ID data for all licensees in their database. Three additional states are actively working towards that goal. Ultimately, the goal is for all fifty-three boards to track FSBPT IDs to help reduce duplicate records in the ELDD.

Licensure Data

The next data set is Licensure Data. Each board has its own licensing number format. Including the FSBPT ID with your licensure data helps ensure that each PT and PTA record is singular and unique. This information enables the ELDD to automatically notify all jurisdictions associated with a particular PT or PTA.

As of October 1, 2022, thirty-five Member Boards currently send licensure data on a daily or weekly basis, and three send it monthly. The FSBPT downloads licensure data from public websites or has to purchase the data in nine jurisdictions. And finally, six jurisdictions do not provide licensure data at all.

 
If your board is not from one of the thirty-eight Member Boards that regularly send licensure data to FSBPT, FSBPT wants to know how they can help you in your efforts. For example, several states are finalizing the use of an FSBPT API to transmit ELDD data. APIs, or Application Programming Interfaces, allow software products to communicate data and functionality. In other words, a messenger delivers a request and a response back to you.

Once installed, the FSBPT API will automate the reporting task by communicating with your licensing software to extract licensing data and transmit it directly to ELDD. This software helps streamline business operations and improve the efficiency and accuracy of your reporting. Nine states are currently implementing this tool to send licensure data by the end of 2022.

Disciplinary Data

The final data set is disciplinary data. We all understand the importance of sharing disciplinary data.
While the vast majority of practitioners are competent and caring individuals who provide care according to the standards, violations do occur. Therefore, the timely reporting of disciplinary actions is crucial to state boards to effectively oversee and regulate the practice of physical therapy.

Even though states are required to report disciplinary actions to the National Practitioner Databank (NPDB), this is not sufficient. The ELDD provides a profession-specific database in which disciplinary actions can be entered online through the FSBPT Online Processing System (Jurisdiction Interface).

As of October 1, 2022, thirty-five boards currently report discipline via the online processing system (OPS). In seventeen jurisdictions, the FSBPT serves as the agent for the submission of disciplinary data to the National Practitioner Data Bank. By using the FSBPT as the agent, boards only have to enter the discipline once—and the FSBPT forwards the report on their behalf.

Five boards send board orders via email, and thirteen boards do not provide disciplinary data at all. As stated earlier, data sharing plays a critical role in our shared mission of public protection. The effectiveness of the ELDD is completely up to the member boards. We need member boards to share their data and make the ELDD a complete, robust tool for public protection.

The PT Compact

What is the link between the ELDD and the PT Compact? The PT Compact has served as a mechanism for strengthening the ELDD as an informational database and improving the cross-jurisdictional sharing of information. In fact, membership in the PT Compact carries with it certain information-sharing requirements:

• Weekly submission of licensure files from member states
• New and transferred scores entered via FSBPT OPS
• Currently, member states are required to report and finalize all adverse actions within 14 days of the effective date
• Member states are required to adopt use of the FSBPT ID as the numerical identifier for licensees, to move away from the use of the SSN

On the FSBPT side, part of the Compact's design was to improve information sharing, including through the ELDD. In just four years, the PT Compact has helped to bring additional states on board with sharing information.

However, the improvement of the ELDD through the Compact benefits all states, not just Compact member states. Not only can information about state licensure be shared through the ELDD—for example, when states are looking in the interface to find out where a licensee may also hold licenses or compact privileges—but states can receive information on disciplinary actions through adverse action reports.

We've come a long way toward full participation, but we have not yet achieved it. The goal now is to move the needle toward full participation. How do we figure out where everyone is on this journey? How do we “fill our tank”?

ELDD Quality and State Participation Task Force

The ELDD Quality and State Participation Task Force, chaired by Megan Certo, was created to provide recommendations to the Board of Directors on how to continue to move that needle forward and reach full participation. The official mission was “to explore ways to improve the quality of and participation in the ELDD and make recommendations to the FSBPT Board of Directors.” For the Task Force to understand where they wanted to go, they had to look back at where FSBPT had been.

You may recall the “5 star” system that rated states in four areas: Licensure, Discipline, Scores, and Overall. For example, a state could be a 5-star state in licensing, a 3-star state in discipline, a 5-star state for exam scores, and a 4-star state overall. The ratings were based on a number of individual factors that FSBPT staff calculated. In the early years of the 5-star system, there was quite a lot of improvement in participation. We went from only one 5-star state in 2013 to fourteen in 2017 and twenty-six in 2020.

There was an initial excitement level in raising a state’s star rating. The PT Compact also helped to “rev” some of the engines. However, in 2020, participation numbers became static; that forward momentum seemed to stall. States did not always know what steps they could take to enhance their rating or increase their participation. That was, in part, due to the complexity of the star rating system.

There were more than twenty-five individual measurements for a state’s participation. Updating the star ratings required a manual review and multi-step calculations. Additionally, the system was time-consuming for FSBPT staff. In fact, some of the ratings themselves were enhanced or inflated by the support provided by FSBPT staff, who, at times, did the following tasks:

• Reviewed and updated outdated licensure information
• Reviewed score reports and input new licenses that were issued
• Entered disciplinary information from individual board orders emailed from states to FSBPT staff
• Researched individual board websites for disciplinary information

With all of those factors in mind, the Task Force began to ask several questions:

• What should a new rating system look like?
• What should a new rating system accomplish?
• How can we use a simple model to convey the current status and continued efforts of a jurisdiction, while still emphasizing public protection?

Imagine for a moment that we are all on a road trip together. We start wherever each jurisdiction is right now. Some have further to go than others, but the goal remains the same: Public protection!

Like any road trip, we all share the same roads. Most drivers obey the rules and drive as safely as possible. However, carelessness, inattention, and distractions can all cause problems. Sometimes they cause accidents, and these accidents don’t just affect the cars involved—there may be secondary accidents, delays due to backups, and detours, all to avoid the mess that someone else caused.

Many people use GPS on road trips to help direct us from point A to point B. But we also know that these directions are only as good as the information in the system. Construction, road hazards, and accidents affect everyone on the road, but most GPS systems also have a way for individual drivers to report these problems. We do it to help others, to direct them to safety and get them to their destination with fewer delays. That way, even if you are stuck, each driver can help all the other drivers on the road to be aware of potential problems ahead.

As jurisdictions, we are the drivers on this road to public protection, and it is our responsibility to alert others to potential danger ahead. We can do this by reporting issues related to licensure and discipline to the ELDD. By reporting an issue to the ELDD, any jurisdiction on the road with that problem licensee is alerted to the danger and knows to react appropriately. The problem is that too few of us are actually making these reports, and this has the potential to cause a chain reaction of issues. Like a GPS, the information in the ELDD is only as good as what is reported by those actually on this road.

Take a moment to think about some of the problem licensees you have encountered on your boards…the “bad drivers” if you will. Do you want them on the road (or in the clinic) with your friends and family? Based on their record in your state, would you agree that they have the potential to cause problems in other states as well? Bad driving doesn’t change just because it crosses state lines. Neither does negligent, unethical, predatory, fraudulent, or incompetent practice. But we can’t protect ourselves and our patients if we don’t know.

The Task Force came to the consensus that something needed to be done to continue to improve information sharing. FSBPT needed a roadmap, a better way to understand where the communication is breaking down and how to fix it. And the way to do that is to have boards connect with other boards. The value is simple, we are here for the same reason—Public Protection—the very reason for a Boards existence. We serve solely in the interest of the consumers of physical therapy services.
In this day and age, information is key. With a reliable jurisdictional database, working with the best, most accurate, most timely information, we can vet our applicants better, and we can alert other jurisdictions of issues almost in real-time. And ultimately, potentially, we can stop bad things from happening.

Technology is advancing and our profession is very mobile and becoming more so every day. With the advent of things like telehealth and licensure compacts makes sharing data more critical now than ever. One thing is clear; not sharing information on our licensees across jurisdictions puts everyone at risk. The ELDD only works if we all make the effort, if we all contribute.
FSBPT understands there are real—as well as perceived—barriers that are preventing jurisdictions from sharing their information. For example, technology, cost, time, board resources, legal/legislative authority, and privacy are all roadblocks to many jurisdictions. Many other boards have those very same problems. However, boards should not be discouraged. The goal is participation, not perfection.

The framework is ready—FSBPT has given boards the tools. Now is the time to reprioritize your involvement. As a first step, commit to identifying your state’s barriers—figure out what is preventing participation. Then start moving towards a change for the better.

FSBPT member boards can do this together. FSBPT can help, and other boards can help. And together, we can advance our shared goal of public protection and keeping patients safe.