Military Health Care:

Defense Health Agency Processes for Responding to Provider Quality and Safety Concerns

GAO-21-160R: Published: Dec 1, 2020. Publicly Released: Dec 1, 2020.

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Contact:

Sharon M. Silas
(202) 512-7114
Silass@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

Physicians, dentists, and other practitioners who want to provide care at military hospitals and clinics must receive permission from the Department of Defense to do so. DOD routinely monitors providers at military facilities to make sure they provide safe, high-quality care.

What happens if the care a provider gives is questioned?

DOD reviews such concerns and determines whether to limit or revoke a provider's permission to provide care for the military. If a provider's permission is revoked, DOD must report it to a national database that tracks disciplinary actions taken against providers, and to the states where the provider is licensed.

A stethoscope and military tags on a flag

Additional Materials:

Contact:

Sharon M. Silas
(202) 512-7114
Silass@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

What GAO Found

The Defense Health Agency (DHA) within the Department of Defense (DOD) has established processes for preventing and responding to quality and safety concerns about individual providers delivering health care in military treatment facilities (MTF). Specifically, DHA's August 2019 policy standardized processes for managing health care quality in the Military Health System, which superseded the policies of each of the military services (Air Force, Army, and Navy). These processes include 1) initial and ongoing monitoring of providers; 2) taking action to deny, limit, or remove individual providers' ability to practice, known as adverse privileging action; and 3) reviewing the care delivered by individual providers involved in certain patient safety events, known as potentially compensable event reviews.

For example, DHA policy establishes requirements for taking adverse privileging actions against a provider that either limit the care a provider is allowed to deliver at a facility or prevent the provider from delivering care altogether, when warranted. In particular, DHA policy specifies that the provider's privileges should be placed in summary suspension—a temporary removal of all or a portion of the provider's privileges—while a peer conducts an investigation of the concerns. DHA policy also specifies that summary suspensions lasting greater than 30 days, as well as any final adverse privileging actions, must be reported to the National Practitioner Data Bank (NPDB). The NPDB is an electronic repository that collects and releases information on certain adverse actions and medical malpractice payments related to providers. According to DOD officials, 27 DOD providers were reported to the NPDB for a summary suspension lasting greater than 30 days between February 1, 2020—when this requirement was implemented—and September 30, 2020.

Why GAO Did This Study

DHA supports the delivery of health care to servicemembers and their families throughout the Military Health System. As in all health care delivery settings, concerns may arise about the quality and safety of care delivered by individual health care providers at MTFs. For example, patient safety events—incidents that could have resulted or did result in harm to a patient—may occur during the course of providing health care services and may raise questions about the quality and safety of care delivered. DHA is responsible for ensuring the quality and safety of health care delivered by military and civilian health care providers, including contractors, through its clinical quality management program.

The National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review aspects of DOD's clinical quality management program, including its processes for reviewing the quality and safety of providers' care. This report describes DHA's processes for preventing and responding to quality and safety concerns about individual health care providers at MTFs. In future work, GAO will examine the implementation of these processes at MTFs.

GAO reviewed documentation that contains policy and guidance for these processes, including DHA's August 2019 procedure manual for managing clinical quality management in the Military Health System. GAO also interviewed officials from DHA and each of the military services. We provided a draft of this report to DOD for review and comment. DOD concurred with our report and provided technical comments, which we incorporated as appropriate.

For more information, contact Sharon M. Silas at(202)512-7114 or Silass@gao.gov.

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