VA Health Care:

Physician Peer Review Identifies Quality of Care Problems but Actions to Address Them Are Limited

HEHS-95-121: Published: Jul 7, 1995. Publicly Released: Jul 7, 1995.

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Pursuant to a congressional request, GAO examined the relationship between problem identification and problem resolution in the Department of Veterans Affairs' (VA) physician peer review process, focusing on: (1) how the results of VA peer review are being used in disciplining physicians with performance problems; (2) the impediments to effective peer review; and (3) whether VA is taking action against physicians who are not performing in accordance with professional standards.

GAO found that: (1) actions taken by VA to address quality of care problems are often limited to undocumented discussions with the physicians involved; (2) there is generally no record of the extent to which quality of care problems are addressed or the actions taken to deal with the problems identified; (3) VA is developing practice guidelines and using peer review to help reduce heavy reliance on professional judgment in peer review; and (4) VA medical centers are not reporting many actions taken against physicians to the National Practitioner Data Bank because of their restrictive reporting procedures.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to require service chiefs to fully document all discussions held with practitioners involved in cases that peer reviewers conclude that most experienced, competent practitioners might or would have handled differently.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA agrees with the GAO findings and concurs with the recommendation. VA provided copies of this report to all facilities and a policy directive was issued to the service chiefs requiring adequate documentation of all follow-up actions taken by service chiefs in response to peer review findings.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary of Health to revise the criteria now being used by medical centers to report VA practitioners to the National Practitioner Data Bank so that they are more consistent with the reporting practices now used in the private sector.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA agrees with the GAO findings and concurs with the recommendation. VA revised the criteria being used by VAMCs to report practitioners to the National Practitioner Data Bank, thereby making VA Data Bank participation more consistent in the two identified areas with reporting practices required for the private sector.

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