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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Highlights
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.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress should amend Public Law 99-166 to expand the physician reporting criteria beyond clinical competence. | 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). |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | 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. |
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.
|
| Department of Veterans Affairs | 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. |
ADCMD has issued detailed instructions requiring quarterly reporting of compliance with VA and JCAHO credentialing and privileging requirements by each facility in each region.
|
| Department of Veterans Affairs | 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. |
A circular was issued on August 18, 1989.
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| Department of Veterans Affairs | 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. |
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.
|
| Department of Veterans Affairs | 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. |
VA issued guidance on April 4, 1990.
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| Department of Veterans Affairs | 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. |
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.
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| Department of Veterans Affairs | 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. |
The memorandum of understanding was signed by HHS and VA in November 1990.
|
| Department of Veterans Affairs | 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. |
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.
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