Indian Health Service:

Improvements Needed in Credentialing Temporary Physicians

HEHS-95-46, Apr 21, 1995

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Pursuant to a congressional request, GAO provided information on American Indians' access to quality health care services, focusing on the: (1) Indian Health Service's (IHS) efforts to ensure that temporary physicians working in IHS facilities are qualified and competent to perform assigned duties; and (2) extent that medical services are delayed under the IHS Contract Health Services Program.

GAO found that: (1) IHS patients may be receiving substandard care because IHS is not always aware of temporary physicians who have had performance or disciplinary problems; (2) although IHS requires that temporary physicians possess a current medical license without restrictions, it fails to verify all of the physicians' current or prior licenses; (3) most IHS facilities have contracts with companies that are not required to inform IHS of the status of their physicians' licenses; (4) IHS facilities do not possess a network to share information on the performance of its temporary physicians; (5) although IHS can purchase specialized medical services from non-IHS providers under the Contract Health Services program, preventive care is not always funded; and (6) IHS is implementing legislatively required staff reductions, however, officials are unsure of how these reductions will impact future medical services or expansion programs if appropriations are reduced as well.

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 Assistant Secretary for Health, Public Health Service, should ensure that the Director, IHS, revises the IHS credentials and privileges policy to explicitly state that the status of all state medical licenses, both active and inactive, should be verified.

    Agency Affected: Department of Health and Human Services: Public Health Service

    Status: Closed - Implemented

    Comments: IHS Circular 95-16, "Credentials and Privileges Review Process for the Medical Staff," was approved December 8, 1995, and requires verification of all state licenses, active and inactive.

    Recommendation: The Assistant Secretary for Health, Public Health Service, should ensure that the Director, IHS, develops standard provisions to include in contracts with locum tenens companies that require a company to verify and inform IHS of the status of all state medical licenses, both active and inactive.

    Agency Affected: Department of Health and Human Services: Public Health Service

    Status: Closed - Implemented

    Comments: On June 2, 1995, the Associate Director of IHS's Office of Administration and Management directed all area contracting officers to place in all existing and new contracts language requiring companies that recruit locum tenens to verify and inform IHS of the status of all state medical licenses, both active and inactive.

    Recommendation: The Assistant Secretary for Health, Public Health Service, should ensure that the Director, IHS, establishes a system that will facilitate the dissemination of information among IHS facilities on the performance of temporary physicians who provide services in IHS.

    Agency Affected: Department of Health and Human Services: Public Health Service

    Status: Closed - Implemented

    Comments: On September 29, 1995, IHS contracted with the Federation of State Medical Boards to perform agencywide credentialing checks on a weekly basis of temporary physicians working in IHS facilities. The Federation will provide IHS with information on previous adverse or disciplinary actions taken against these physicians, and the information will be kept in the central office.