VA Health Care:

Improvements Needed in Procedures to Assure Physicians Are Qualified

HRD-89-77: Published: Aug 22, 1989. Publicly Released: Aug 30, 1989.

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Pursuant to a congressional request, GAO examined the Department of Veterans Affairs' (VA) physician credentialing and privileging processes, focusing on: (1) policies, procedures, and implementation of the credentialing program required by law; and (2) VA policies and procedures on granting or rescinding physician privileges.

GAO found that: (1) although VA was required to obtain physician licensing information from state boards, it had only verified and properly documented 102 of 207 physicians it hired between 1986 and 1988; (2) in 34 of the 105 undocumented cases, medical center officials had contacted a cognizant state board, but failed to document the contact; (3) VA planned to require VA-affiliated medical schools to conduct background investigations on the residents they sent to VA; (4) VA took few actions to correct identified problems with its privileging processes; (5) VA had no documentation to show whether it considered current competence, treatment results, or conclusions in its privileging decisions; (6) VA provided only minimal guidance to its medical centers on privileges and no guidance on the documentation required to support privileging decisions; (7) medical centers were reluctant to reduce or revoke physicians' privileges for fear of litigation; (8) although VA was required to notify state licensing boards of physicians who had their privileges formally revoked, the law limited VA to reporting physicians for clinical incompetence; and (9) VA was also reluctant to report physicians who retired or resigned before receiving a hearing because of its concern over their due process rights.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: The Committee has reviewed the report and agency actions, and is determining whether to take action. GAO is planning further work in this area and will reevaluate the need for this action. According to Committee staff, this recommendation may have validity but it was "lost" in the overall concern about VA's poor credentialing and privileging process. The impetus for this recommendation has been lost over the years. GAO's current evaluation into VA's actions when a poorly performing physician is identified, may rekindle activity in this area (job code 101437).

    Matter: Congress should amend Public Law 99-166 to expand the physician reporting criteria beyond clinical competence.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: On November 5, 1991, VA published a new chapter in its Administration Manual which provides policy and procedures on how to provide due process to physicians who resign or retire before receiving a hearing.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to work with the Office of General Counsel to develop a policy and establish guidance on how to provide due process to physicians who resign or retire before receiving a hearing.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: The memorandum of understanding was signed by HHS and VA in November 1990.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to enter into a memorandum of understanding with the Department of Health and Human Services (HHS) and support the National Practitioner Data Bank.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: ADCMD has issued detailed instructions requiring quarterly reporting on credentialing and privileging activities. All managers with credentialing and privileging responsibilities have had specific performance standards established for their annual appraisals and proficiency reports.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to require regional offices to follow up on medical centers' proposed corrective actions and ensure that they have been properly implemented.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: VA issued guidance on April 4, 1990.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to fulfill the commitments made to the House and Senate Veterans' Affairs Committees in 1986 to improve the VA privileging process. This includes issuing privileging guidance that would specify: (1) the documentation needed to support privileging decisions; and (2) the types of physicians that should be privileged.

    Agency Affected: Department of Veterans Affairs

  5. Status: Closed - Implemented

    Comments: Personnel indicated that they collect this information on a separate form, SF 85 Questionnaire for Non-Sensitive Positions, which is used in conjunction with the employment application form.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to revise the VA physician application form to require full disclosure of any drug or alcohol dependency problems.

    Agency Affected: Department of Veterans Affairs

  6. Status: Closed - Implemented

    Comments: A circular was issued on August 18, 1989.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to obtain assurances from affiliated medical schools that residents' backgrounds have been adequately checked before they are sent to VA.

    Agency Affected: Department of Veterans Affairs

  7. Status: Closed - Implemented

    Comments: ADCMD has issued detailed instructions requiring quarterly reporting of compliance with VA and JCAHO credentialing and privileging requirements by each facility in each region.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to incorporate procedures in regional office survey requirements to ensure that each medical center's compliance with VA credentialing guidance is examined and corrective action is taken in a timely manner.

    Agency Affected: Department of Veterans Affairs

  8. Status: Closed - Implemented

    Comments: VA received information from the match. Followup on positive matches was expected to be completed in March 1991. Decisions should be made by July 1991. VA now has a policy requiring medical centers to match the names of its physicians to NPDB at least every 2 years and when the physician is hired.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to fulfill the commitments made to the House and Senate Veterans' Affairs Committees in 1986 to improve the credentialing process. This includes taking the steps necessary to ensure the medical centers' compliance with credentialing guidance and performing a match of VA data regarding currently employed physicians' licenses with data from the Federation of State Medical Boards.

    Agency Affected: Department of Veterans Affairs

 

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