GAO REPORTS ON VA CREDENTIALING, PRIVILEGING AND PRACTITIONER

SCREENING -- As usual, the VA could be doing a better job.

We have three reports...one testimony report and two letter reports.

Full testimony report here... http://www.gao.gov/cgi-bin/getrpt?GAO-06-760T

Highlights of testimony report here... http://www.gao.gov/highlights/d06760thigh.pdf

Highlights of testimony report below:

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Patient Safety Could be Enhanced by Improvements in Employment Screening and Physician Privileging Practices

Why GAO did this study.

In its March 2004 report, VA Health Care: Improved Screening of Practitioners Would Reduce Risk to Veterans, GAO-04-566, GAO made recommendations to improve VA’s employment screening of practitioners. GAO was asked to testify today on steps VA has taken to improve its employment screening requirements and VA’s physician credentialing and privileging processes because of their importance to patient safety. This testimony is based on two GAO reports released today that determined the extent to which (1) VA has taken steps to improve employment screening for practitioners by implementing GAO’s 2004 recommendations, (2) VA facilities are in compliance with selected credentialing and privileging requirements for physicians, and (3) VA has internal controls to help ensure the accuracy of privileging information.

What GAO found.

In its report released today, VA Health Care: Steps Taken to Improve Practitioner Screening, but Facility Compliance with Screening Requirements Is Poor, GAO-06-544, GAO found that VA has taken steps to improve employment screening for practitioners, such as physicians, nurses, and pharmacists, by partially implementing each of four recommendations GAO made in March 2004. However, gaps still remain in VA’s requirements. For example, for the recommendation that VA check all state licenses and national certificates held by all practitioners, such as nurses and pharmacists, VA implemented the recommendation for practitioners it intends to hire, but has not expanded this screening requirement to include those currently employed by VA. In addition, VA’s implementation of another recommendation—to conduct oversight to help facilities comply with employment screening requirements—did not include all screening requirements, as recommended by GAO.

In another report released today, VA Health Care: Selected Credentialing Requirements at Seven Medical Facilities Met, but an Aspect of Privileging Process Needs Improvement, GAO-06-648, GAO found at seven VA facilities it visited compliance with almost all selected credentialing and privileging requirements for physicians. Credentialing is verifying that a physician’s credentials are valid. Privileging is determining which health care services—clinical privileges—a physician is allowed to provide. Clinical privileges must be renewed at least every 2 years. One privileging requirement—to use information on a physician’s performance in making privileging decisions—was problematic because officials used performance information when renewing clinical privileges, but collected all or most of this information through their facility’s quality assurance program. This is prohibited under VA policy. Further, three of the seven facilities did not submit medical malpractice claim information to VA’s Office of Medical-Legal Affairs within 60 days after being notified that a claim was paid, as required by VA. This office uses such information to determine whether VA practitioners have delivered substandard care and provides these determinations to facility officials. When VA medical facilities do not submit all relevant information in a timely manner, facility officials make privileging decisions without the advantage of such determinations.

VA has not required its facilities to establish internal controls to help ensure that physician privileging information managed by medical staff specialists—employees who are responsible for obtaining and verifying information used in credentialing and privileging—is accurate. One facility GAO visited did not identify 106 physicians whose privileging processes had not been completed by facility officials for at least 2 years because of inaccurate information provided by the facility’s medical staff specialist. As a result, these physicians were practicing at the facility without current clinical privileges.

What GAO recommends.

In its reports released today, GAO recommends that VA expand its employment screening oversight program to include all practitioners, provide guidance on collecting physician performance information, enforce the time frame to submit information on paid VA malpractice claims involving VA practitioners, and instruct facilities to establish internal controls for physician privileging information. VA agreed with the findings and conclusions and concurred with the recommendations in both reports.

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First full letter report here... http://www.gao.gov/cgi-bin/getrpt?GAO-06-648

Highlights of first letter report here... http://www.gao.gov/highlights/d06648high.pdf

Highlights of first letter report below:

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Selected Credentialing Requirements at Seven Medical Facilities Met, but an Aspect of Privileging Process Needs Improvement

Why GAO did this study.

The Department of Veterans Affairs (VA) is responsible for determining that over 36,000 physicians working in its facilities have the appropriate professional credentials and qualifications to deliver health care to veterans. To do this, VA credentials and privileges physicians providing care at its medical facilities. In this report, GAO determined the extent to which selected VA facilities complied with (1) four VA credentialing requirements and five VA privileging requirements and (2) a requirement to submit information on paid malpractice claims. GAO also determined (3) whether VA has internal controls to help ensure the accuracy of information used to renew clinical privileges. GAO reviewed VA’s policies, interviewed VA officials, and randomly sampled 17 physician files at each of seven VA medical facilities.

What GAO found.

GAO found that the files reviewed at seven VA medical facilities complied with four of VA’s credentialing requirements selected for review, and all but one of five privileging requirements. Credentialing is the process of verifying that a physician’s professional credentials, such as state medical licenses, are valid and meet VA’s requirements for employment. Privileging is the process for determining which health care services a physician is allowed to provide to veterans. For the files GAO reviewed, compliance with the fifth privileging requirement was problematic at six facilities because officials used performance information when renewing clinical privileges but collected all or most of this information through their facility’s quality assurance program. This is prohibited under VA policy. In general, VA quality assurance information is confidential, according to federal law and VA policy. According to VA officials, if quality assurance information is used outside of a facility’s quality assurance program, it could be used for other purposes, including litigation. The information is protected to encourage physicians to participate in quality assurance programs by reporting and discussing adverse events to help prevent such events from occurring in the future. VA has not provided guidance to help medical facilities find ways to efficiently collect performance information outside of a facility’s quality assurance program. At the seventh medical facility, officials did not use performance information to renew clinical privileges, as required.

Three of the seven medical facilities did not meet VA’s requirement to submit, within 60 days after being notified that the claim was paid, any information on paid VA medical malpractice claims involving facility practitioners, including physicians, to VA’s Office of Medical-Legal Affairs. This office reviews the information and determines whether practitioners involved in the claims delivered substandard care, displayed professional incompetence, or engaged in professional misconduct. The office informs facilities of its determinations. When facilities do not submit all relevant VA malpractice information in a timely manner, VA medical facility officials lack complete information that would allow them to make informed decisions about the clinical privileges that their physicians should be granted.

VA has not required its medical facilities to establish internal controls to help ensure that privileging information managed by medical staff specialists—who are responsible for obtaining and verifying the information used in the credentialing and privileging processes—is accurate. One facility GAO visited did not identify 106 physicians whose privileging process had not been completed by facility officials for at least 2 years because of inaccurate information provided by the facility’s medical staff specialist. As a result, these physicians were practicing at the facility without current clinical privileges. Without accurate information on the privileges that have been granted to physicians and the dates for renewing those privileges, VA medical facility officials will not know if they have failed to renew clinical privileges for any of their physicians in accordance with VA policy.

What GAO recommends.

GAO recommends that VA provide guidance to its medical facilities on how to collect physician performance information in accordance with VA’s policy that can be used to renew clinical privileges, enforce the timely submission of VA medical malpractice information, and instruct facilities to establish internal controls for privileging information. VA concurred with the findings and recommendations and provided an action plan to implement the three recommendations.

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Second full letter report here... http://www.gao.gov/cgi-bin/getrpt?GAO-06-544

Highlights of second letter report here... http://www.gao.gov/highlights/d06544high.pdf

Highlights of second letter report below: 

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Steps Taken to Improve Practitioner Screening, but Facility Compliance with Screening Requirements Is Poor

Why GAO did this study.

In March 2004, GAO reported on gaps in VA’s requirements for screening the professional credentials and personal backgrounds of health care practitioners (GAO-04-566). GAO found that VA’s requirements did not ensure thorough screening of VA practitioners. VA concurred with four recommendations GAO made to improve practitioner screening.

GAO was asked to determine the extent to which (1) VA has taken steps to improve practitioner screening by implementing GAO’s recommendations and (2) VA facilities are in compliance with VA’s practitioner screening requirements. GAO reviewed VA’s current practitioner screening policies to determine if gaps remain, interviewed VA officials, and sampled about 60 practitioner files at each of seven VA facilities selected based on size and geographic location.

What GAO found.

VA has taken steps to improve health care practitioner screening by partially implementing each of four recommendations made in GAO’s March 2004 report; however, gaps still remain in VA’s practitioner screening requirements. In response to two of GAO’s recommendations, VA expanded its screening requirements for all VA applicants to include a verification of all state licenses and national certificates and requires facility officials to query the Healthcare Integrity and Protection Data Bank (HIPDB), which contains information on individuals involved in health care-related civil judgments and criminal convictions and licensing and certification actions. VA, however, has not yet expanded these screening requirements to apply to all health care practitioners currently employed at VA facilities, as GAO recommended. In response to the third GAO recommendation, VA issued a policy in August 2005 that requires individuals who previously were exempt from receiving any level of background investigation to have, at a minimum, their fingerprints screened against a criminal history database. As of October 19, 2005, 37 VA medical facilities had not fully implemented this new requirement because they had not obtained or installed the necessary electronic fingerprint equipment. Since then VA has made progress; as of February 1, 2006, 2 medical facilities had not installed the equipment. Finally, VA has partially implemented GAO’s fourth recommendation to conduct oversight of its facilities’ compliance with VA practitioner screening requirements; however, GAO found the oversight does not address all of the facility compliance issues GAO previously identified.

GAO found poor compliance with four of the five selected VA practitioner screening requirements at the seven VA facilities visited in 2005. None of the seven facilities had a compliance rate of 90 percent or more for all five screening requirements GAO reviewed. Two facilities that had implemented VA’s fingerprint-only background investigations—a relatively new form of background investigation—did not comply with VA’s requirement to document that the results of the fingerprint check against a criminal history database had been reviewed and used to make a decision on the individual’s suitability to work at a VA medical facility.

What GAO recommends.

GAO recommends that VA expand its oversight program to include a review of VA screening requirements for all types of health care practitioners and that VA standardize a method for documenting the review of fingerprint-only investigation results. VA agreed with GAO’s findings and concurred with the recommendations. VA further stated that it will provide an action plan on how it will implement the recommendations at a later date.

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Larry Scott

(go back to VA Watchdog dot Org Home Page)

	Web www.vawatchdog.org

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