VA Health Care
Improvements Made in Physician Privileging Policies, but Medical Facility Compliance Has Not Been Assessed Gao ID: GAO-08-271T November 6, 2007In a report issued in May 2006, GAO examined compliance with the Department of Veterans Affairs' (VA) physician credentialing and privileging requirements at seven VA medical facilities GAO visited. VA's credentialing process is used to determine whether a physician's professional credentials, such as licensure, are valid and meet VA's requirements for employment. VA's privileging process is used to determine which health care services or clinical privileges, such as surgical procedures, a VA physician is qualified to provide to veterans without supervision. Although GAO cannot generalize from its findings, GAO found that the seven facilities were complying with credentialing requirements. However, the facilities were not complying with aspects of certain privileging requirements. To better ensure that VA physicians are qualified to deliver care safely to veterans, GAO made three recommendations to improve VA's privileging of physicians. GAO was asked to testify on (1) how VA credentials and privileges physicians working in its medical facilities and (2) the extent to which VA has implemented the three recommendations made in GAO's May 2006 report that address VA's privileging requirements. To update its issued work, GAO reviewed VA's policies, procedures, and correspondence related to physician privileging and interviewed VA central office officials to determine if the recommendations made in GAO's May 2006 report were implemented.
The Department of Veterans' Affairs (VA) has specific requirements that medical facility officials must follow to credential and privilege physicians. VA requires its medical facility officials to credential and privilege facility physicians periodically so that they can continue to work at VA. Facility officials verify the information used in the credentialing process and query certain databases that contain information on disciplinary actions that have been taken against a physician's state medical license and have information about a physician's professional competence. Each physician also must complete a written request for clinical privileges that is reviewed by the physician's supervisor who considers whether the physician has the appropriate professional credentials, training, and work experience. In addition, every 2 years, the supervisor is to consider information on a physician's performance, such as a physician's surgical complication rate, when deciding whether to renew a physician's clinical privileges. In a May 2006, GAO examined compliance with VA's physician credentialing and privileging requirements at seven VA medical facilities it visited and made three recommendations designed to improve aspects of privileging and oversight of the process. The three recommendations were (1) to provide guidance to medical facilities on how to collect individual physician performance information in accordance with VA's credentialing and privileging policy to use in medical facilities' privileging process, (2) to enforce the requirement that medical facilities submit information on paid VA medical malpractice claims to VA within 60 days after being notified that the claim is paid, and (3) to instruct medical facilities to establish internal controls to ensure the accuracy of their privileging information. VA reports that it has implemented all three recommendations by establishing policy and guidance for its medical facilities. However, GAO does not know the extent of compliance with these requirements at VA medical facilities.
GAO-08-271T, VA Health Care: Improvements Made in Physician Privileging Policies, but Medical Facility Compliance Has Not Been Assessed
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United States Government Accountability Office:
GAO:
Testimony:
Before the Committee on Veterans' Affairs, U.S. Senate:
For Release on Delivery:
Expected at 9:30 a.m. EST:
Tuesday, November 6, 2007:
VA Health Care:
Improvements Made in Physician Privileging Policies, but Medical
Facility Compliance Has Not Been Assessed:
Statement of Randall B. Williamson:
Acting Director, Health Care:
GAO-08-271T:
GAO Highlights:
Highlights of GAO-08-271T, a testimony before the Committee on
Veterans‘ Affairs, U.S. Senate.
Why GAO Did This Study:
In a report issued in May 2006, GAO examined compliance with the
Department of Veterans Affairs‘ (VA) physician credentialing and
privileging requirements at seven VA medical facilities GAO visited.
VA‘s credentialing process is used to determine whether a physician‘s
professional credentials, such as licensure, are valid and meet VA‘s
requirements for employment. VA‘s privileging process is used to
determine which health care services or clinical privileges, such as
surgical procedures, a VA physician is qualified to provide to veterans
without supervision. Although GAO cannot generalize from its findings,
GAO found that the seven facilities were complying with credentialing
requirements. However, the facilities were not complying with aspects
of certain privileging requirements. To better ensure that VA
physicians are qualified to deliver care safely to veterans, GAO made
three recommendations to improve VA‘s privileging of physicians. GAO
was asked to testify today on (1) how VA credentials and privileges
physicians working in its medical facilities and (2) the extent to
which VA has implemented the three recommendations made in GAO‘s May
2006 report that address VA‘s privileging requirements. To update its
issued work, GAO reviewed VA‘s policies, procedures, and correspondence
related to physician privileging and interviewed VA central office
officials to determine if the recommendations made in GAO‘s May 2006
report were implemented.
What GAO Found:
VA has specific requirements that medical facility officials must
follow to credential and privilege physicians. VA requires its medical
facility officials to credential and privilege facility physicians
periodically so that they can continue to work at VA. Facility
officials verify the information used in the credentialing process and
query certain databases that contain information on disciplinary
actions that have been taken against a physician‘s state medical
license and have information about a physician‘s professional
competence. Each physician also must complete a written request for
clinical privileges that is reviewed by the physician‘s supervisor who
considers whether the physician has the appropriate professional
credentials, training, and work experience. In addition, every 2 years,
the supervisor is to consider information on a physician‘s performance,
such as a physician‘s surgical complication rate, when deciding whether
to renew a physician‘s clinical privileges.
In a May 2006, GAO examined compliance with VA‘s physician
credentialing and privileging requirements at seven VA medical
facilities it visited and made three recommendations designed to
improve aspects of privileging and oversight of the process. The three
recommendations were to
* provide guidance to medical facilities on how to collect individual
physician performance information in accordance with VA‘s credentialing
and privileging policy to use in medical facilities‘ privileging
process,
* enforce the requirement that medical facilities submit information on
paid VA medical malpractice claims to VA within 60 days after being
notified that the claim is paid, and
* instruct medical facilities to establish internal controls to ensure
the accuracy of their privileging information.
VA reports that it has implemented all three recommendations by
establishing policy and guidance for its medical facilities. However,
GAO does not know the extent of compliance with these requirements at
VA medical facilities.
To view the full product, including the scope and methodology, click on
[hyperlink, http://www.GAO-08-271T]. For more information, contact
Randall B. Williamson at (202) 512-7114 or williamsonr@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
I am pleased to be here today as you discuss physician hiring practices
at medical facilities operated by the Department of Veterans Affairs
(VA). VA has over 36,000 physicians working at more than 1,300
facilities in its health care system. To help ensure the quality of the
health care these physicians deliver and the safety of veterans, VA is
responsible for determining that its physicians have the appropriate
professional credentials and clinical experience to provide health care
to VA's patients. To do this, VA requires physicians to undergo
credentialing and privileging. VA's credentialing process is used to
determine whether a physician's professional credentials, such as
licensure, education, and training, are valid and meet VA's
requirements for employment. VA's privileging process is used to
determine which health care services or clinical privileges, such as
surgical procedures or administering anesthesia, a VA physician is
qualified to provide to veterans without supervision. VA physicians
must be credentialed and privileged when they apply to work in VA--
which is known as initial appointment--and at least once every 2 years
thereafter when they must reapply for a position on the facility's
medical staff. These subsequent reviews are known as the process of
reappointment.
In a report we issued in May 2006, we examined compliance with select
credentialing and privileging requirements at seven VA medical
facilities we visited and made three recommendations designed to
improve aspects of privileging and oversight of the process. Although
we cannot generalize from our findings, we found that these facilities
were complying with credentialing requirements. However, they were not
complying with aspects of certain privileging requirements.[Footnote 1]
For example, VA medical facilities were not submitting information on
paid medical malpractice claims within the 60-day required time frame
to VA's office that reviews the claims information and makes a
determination about whether physicians involved in the claims delivered
substandard care to veterans. VA generally agreed with our findings,
conclusions, and recommendations.
Today, I will discuss the progress VA has made in implementing our May
2006 recommendations to address noncompliance with VA's privileging
requirements. Specifically, I will discuss (1) how VA credentials and
privileges physicians working in its medical facilities and (2) the
extent to which VA has implemented the three recommendations made in
our May 2006 report that address VA's privileging requirements.
To perform our 2006 review, we selected four of VA's credentialing
requirements for review because they are requirements that--unlike
others--address information about physicians that can change or be
updated with new information periodically. As a result, VA requires
that this information be verified by medical facility officials when a
physician initially applies for employment at VA and at least every 2
years thereafter. Under the four requirements we reviewed, VA medical
facility officials must:
1. verify that all state medical licenses held by physicians are valid;
2. query the Federation of State Medical Boards (FSMB) database to
determine whether physicians had disciplinary action taken against any
of their licenses, including expired licenses;
3. verify information provided by physicians on their involvement in
medical malpractice claims at a VA or non-VA facility; and:
4. query the National Practitioner Data Bank (NPDB) to determine
whether a physician was reported to this data bank because of
involvement in VA or non-VA paid medical malpractice claims, display of
professional incompetence, or engagement in professional misconduct.
Of the privileging requirements in VA's credentialing and privileging
policy, we selected four requirements that VA identifies as general
privileging requirements. In addition, we selected another privileging
requirement about the use of individual performance information because
of its importance in the renewal of clinical privileges. The five VA
privileging requirements we selected were as follows:
1. verify that all state medical licenses held by physicians are valid;
2. verify physicians' training and experience;
3. assess physicians' clinical competence and health status;
4. consider any information provided by a physician related to medical
malpractice allegations or paid claims, loss of medical staff
membership, loss or reduction of clinical privileges at a VA or non-VA
facility, or any challenges to a physician's state medical license;
and:
5. use information on a physician's performance when making decisions
about whether to renew the physician's clinical privileges.
Two of the five privileging requirements--verify all state medical
licenses and consider medical malpractice information--are also VA
credentialing requirements we reviewed.
To update our work, we reviewed VA's policies, procedures, and
correspondence related to physician privileging and interviewed VA
central office officials to determine if the recommendations we made in
our May 2006 report were implemented. We updated our issued work in
July 2007 and November 2007, and we performed all of our work in
accordance with generally accepted government auditing standards.
In summary, VA has specific requirements that medical facility
officials must follow to credential and privilege physicians. VA
requires its medical facility officials to credential and privilege
facility physicians periodically so that they can continue to work at
VA. We reported in May 2006 that the seven VA medical facilities we
visited complied with the four credentialing requirements we reviewed
and all but one of the five privileging requirements we reviewed.
However, during our review, we found that medical facility officials
did not have all of the information they needed on physicians involved
in paid VA medical malpractice claims, because the facilities had not
submitted such information in a timely manner to VA's office that
reviews the claims information and makes a determination about whether
physicians involved in the claims delivered substandard care to
veterans. We also found during our review that VA did not require its
medical facilities to establish internal controls to help ensure the
accuracy of their privileging information. Without internal controls VA
medical facility officials did not know if they properly renewed
clinical privileges, thereby allowing physicians to practice with
expired clinical privileges. Since our 2006 review, VA reports that it
has implemented all three of our recommendations to improve VA's
physician privileging process. However, since our work in 2006 we have
not visited or examined records at facilities to determine the extent
of compliance.
Background:
VA operates the largest integrated health care system in the United
States, providing care to nearly 5 million veterans per year. The VA
health care system consists of hospitals, ambulatory clinics, nursing
homes, residential rehabilitation treatment programs, and readjustment
counseling centers. VA delegates decision making regarding financing,
health care service delivery, and medical facility operations to its 21
networks.
Physicians who work at VA medical facilities are required to hold at
least one current and unrestricted state medical license. Current and
unrestricted licenses are those in good standing in the states that
issued them, and licensed physicians may hold licenses from more than
one state. State medical licenses are issued by state licensing boards,
which generally establish state licensing requirements governing their
licensed practitioners.[Footnote 2] To keep licenses current,
physicians must renew their licenses before they expire and meet
renewal requirements established by state licensing boards, such as
continuing education. Renewal procedures and requirements vary by
state. When state licensing boards discover violations of licensing
practices, such as the abuse of prescription drugs or the provision of
substandard care that results in adverse health effects, they may place
restrictions on licenses or revoke them. Restrictions issued by a state
licensing board can limit or prohibit a physician from practicing in
that particular state. Generally, state licensing boards maintain a
database that contains information on any restrictions or revocations
of physicians' licenses.
VA's Credentialing and Privileging Processes:
Credentialing Process:
When physicians apply for initial appointment, they initiate the
credentialing process by completing VA's application, which includes
entering into VetPro--a Web-based credentialing system VA implemented
in March 2001--information used by VA medical facility officials in the
credentialing process. Among the credentialing information that VA
requires physicians enter into VetPro is information on all the state
medical licenses they have ever held, including any licenses they have
held that have expired. For their reappointments, physicians must
update this credentialing information in VetPro.
Once physicians enter their credentialing information into VetPro, a
facility's medical staff specialist--an employee who is responsible for
obtaining and verifying the information used in the credentialing and
privileging processes--performs a data check on the information to be
sure that all required information has been entered. In general, the
medical staff specialist at each VA medical facility manages the
accuracy of VetPro's credentialing data. The medical staff specialist
verifies, with the original source of the information, the accuracy of
the credentialing information entered by the physicians. This type of
check is known as primary source verification. For example, the medical
staff specialist contacts state licensing boards in order to verify
that physicians' state medical licenses are valid and unrestricted.
At initial appointment only, VA requires medical staff specialists to
query FSMB, which contains information from state licensing boards.
This query enables officials to determine all the state medical
licenses a physician has ever held, including those not disclosed by a
physician to VA, and whether a physician has had any disciplinary
actions taken against these licenses. VA does not require this query at
reappointment because VA headquarters regularly receives reports from
FSMB on any VA physician whose name appears on FSMB's list, indicating
that disciplinary action has been taken against the physician's state
medical license. When VA headquarters receives a report from FSMB, it
notifies the appropriate VA medical facility.
VA's credentialing process requires VA medical staff specialists to
verify medical malpractice claims at initial appointment and at
reappointment. These claims may be verified by contacting a court of
jurisdiction or the insurance company involved in the medical
malpractice claims, or by obtaining a statement of claims status from
the attorney representing the physician in the medical malpractice
claim. In addition, VA requires medical staff specialists to query
NPDB, which contains reports by state licensing boards, hospitals, and
other health care entities on unprofessional behavior on the part of
physicians or adverse actions taken against them. This query enables
officials to determine whether physicians fully disclosed to VA any
involvement they might have had in paid medical malpractice
claims.[Footnote 3] Once a physician's credentialing information has
been verified, the medical staff specialist sends the information to
the physician's supervisor, who is known as a clinical service
chief.[Footnote 4] The clinical service chief reviews this information
along with the physician's privileging information. Figure 1
illustrates VA's credentialing process.
Figure 1: Steps Taken in VA's Physician Credentialing Process:
[See PDF for image]
This figure is a flow chart of the steps taken in VA's Physician
Credentialing process. The following data is depicted:
Initial appointment and reappointment:
Medical staff specialist gives physician access to VetPro;
Initial appointment:
Physician enters information into VetPro that includes:
* All state medical licenses including expired licenses;
* Any involvement in paid or settled medical malpractice claims;
Reappointment:
Physician updates information stored in VetPro from initial
appointment.
Initial appointment and reappointment:
Medical staff specialist checks completeness of VetPro information;
Performs primary source verification of VetPro information;
Queries FSMB (only at initial appointment);
Queries NPDB;
Sends VetPro information to clinical service chief.
Initial appointment and reappointment:
Clinical service chief reviews information sent by the medical staff
specialist and considers it along with the physician‘s privileging
information.
Source: GAO analysis of VA credentialing policy.
[End of figure]
Privileging Process:
Physicians, in addition to entering credentialing information into
VetPro, must complete a written request for clinical privileges. The
facility medical staff specialist provides a physician's clinical
service chief with the physician's requested clinical privileges and
information needed to complete the privileging process, including
information that indicates that the credentialing information entered
by the physician into VetPro has been verified with the appropriate
sources. For reappointment, documentation is required by another
physician stating that the physician is able to perform both physically
and mentally the clinical privileges requested. In addition, the
medical staff specialist provides the clinical service chief with
information on medical malpractice allegations or paid claims, loss of
medical staff membership, loss or reduction of clinical privileges, or
any challenges to the physician's state medical licenses.
The requested clinical privileges are reviewed by a clinical service
chief, who recommends whether a physician should be appointed or
reappointed to the facility's medical staff and which clinical
privileges should be granted. When deciding to recommend clinical
privileges, a clinical service chief considers whether the physician
has the appropriate professional credentials, training, and work
experience to perform the privileges requested. For reappointment only,
a clinical service chief is to consider observations of the physician's
delivery of health care to veterans, and VA's policy requires that
information on a physician's performance, such as a physician's
surgical complication rate, be used when deciding whether to renew a
physician's clinical privileges. Based on the clinical service chief's
observations and the physician's performance information, the clinical
service chief recommends that clinical privileges previously granted by
the facility remain the same, be reduced, or be revoked, and whether
newly requested privileges should be added.[Footnote 5]
Clinical service chiefs forward their recommendations and the reasons
for the recommendations to the next level of a medical facility's
privileging review process, which may be a professional standards board
or a medical executive committee.[Footnote 6] A medical facility
professional standards board or the medical executive committee reviews
the recommendations of the clinical service chief and recommends to the
facility director whether the physician should be appointed to the
facility's medical staff and which clinical privileges should be
granted to the physician. The 2-year time period for renewal of
clinical privileges and reappointment to the medical staff begins on
the date that the privileges are approved by the medical facility's
director. The list of approved clinical privileges with the date of
approval is maintained at VA medical facilities and the initial
appointment or reappointment date is entered into VetPro. Figure 2
illustrates VA's privileging process.
Figure 2: Steps Taken in VA's Physician Privileging Process:
[See PDF for image]
This figure is a flow chart of the steps taken in VA's Physician
Privileging process. The following data is depicted:
Initial appointment and reappointment:
Physician completes written request for specific clinical privileges;
Medical staff specialist sends physician‘s clinical privilege request
to clinical service chief with information that includes:
* verification of credentialing information;
* verification of physician‘s training and experience;
* assessment of physician‘s clinical competence and health status;
Clinical service chief reviews information sent by medical staff
specialist and recommends whether physician should be appointed and the
clinical privileges that should be granted, then sends the
documentation and recommendation to the facility‘s professional
standards board/medical executive committee;
(For reappointment only: Clinical service chief also reviews
information on physician‘s performance);
Professional standards board/medical executive committee reviews
information and recommends whether physician should be appointed and
the clinical privileges that should be granted, then sends
documentation and recommendation to facility director;
Facility director makes final decision to approve a physician‘s
appointment or reappointment and recommends clinical privileges.
Source: GAO analysis of VA privileging policy.
[End of figure]
According to VA's policy and a VA memorandum, information concerning
individual physician performance that is used as part of the
privileging process to either reduce, revoke, or support[Footnote 7]
granting clinical privileges must be collected separately from a
medical facility's quality assurance program.[Footnote 8] VA's policy
is based on a federal law that restricts the disclosure of documents
produced in the course of VA's quality assurance program.[Footnote 9]
In general, documents created in connection with such a program are
confidential and may not be disclosed except in limited
circumstances.[Footnote 10] Individuals who willfully disclose
documents that they know are protected quality assurance documents are
subject to fines up to $20,000. Although the law states that it is not
intended to limit the use of documents within VA, VA's policy expressly
prohibits the use of such documents in connection with the privileging
process. VA's use of separate information sources for quality assurance
and privileging decisions is intended to maintain the confidential
status of documents produced in connection with quality assurance
programs. According to VA, the confidentiality of individual
performance information helps ensure provider participation, including
physicians, in a medical facility's quality assurance program by
encouraging providers to openly discuss opportunities for improvement
in provider practice without fear of punitive action.
VA has another requirement that is related to the renewal of
physicians' clinical privileges. Medical facility officials are
required to submit to VA's Office of Medical-Legal Affairs information
on paid VA malpractice claims. This information must be submitted
within 60 days after the medical facility is notified about a paid
malpractice claim. The Office of Medical-Legal Affairs is responsible
for convening a panel of clinicians to determine whether a VA facility
physician involved in the claim delivered substandard care. The Office
of Medical-Legal Affairs notifies the medical facility director of the
results of its review. If it is determined that the physician delivered
substandard care to veterans, the medical facility must report the
physician to NPDB within 30 days of being notified of the decision. VA
medical facility officials also would use this determination to decide
whether to grant clinical privileges to the physician involved in the
VA medical malpractice claim.
VA Has Addressed All GAO Physician Privileging Recommendations, but
Extent of Medical Facility Compliance Is Unknown:
In our 2006 report, we found that the physician files at the seven
facilities we visited demonstrated compliance with four VA
credentialing and four privileging requirements we reviewed.[Footnote
11] However, we found that there were problems complying with a fifth
privileging requirement--to use information on a physician's
performance in making privileging decisions. We also found during our
review that three of the seven medical facilities we visited did not
submit to VA's Office of Medical-Legal Affairs information on paid VA
medical malpractice claims within 60 days after being notified that a
claim was paid, as required by VA policy. Further, VA had not required
its medical facilities to establish internal controls to help ensure
that privileging information managed by medical staff specialists is
accurate. Internal controls are important because at one facility we
visited we found 106 physicians whose privileging process had not been
completed by facility officials for at least 2 years because of
inaccurate information. As a result, these physicians were practicing
at the facility with expired clinical privileges. None of the VA
medical facilities we visited for our 2006 report had internal controls
in place that would prevent a similar situation from occurring. To
better ensure that VA physicians are qualified to deliver care safely
to veterans, we recommended that VA:
* provide guidance to medical facilities on how to collect individual
physician performance information in accordance with VA's credentialing
and privileging policy to use in medical facilities' privileging
process,
* enforce the requirement that medical facilities submit information on
paid VA medical malpractice claims to VA's Office of Medical-Legal
Affairs within 60 days after being notified that the claim is paid,
and:
* instruct medical facilities to establish internal controls to ensure
the accuracy of their privileging information.
VA states that it has implemented all three recommendations we made in
our May 2006 report to address compliance with VA's physician
privileging requirements by establishing policy and guidance for its
medical facilities. However, we do not know the extent of compliance
with these requirements at VA medical facilities.
VA implemented our recommendation that VA provide guidance to VA
medical facilities on how to appropriately collect information on
individual physician performance and use that information in VA's
privileging process. Physician performance information is to be used to
assist VA medical facility clinical service chiefs in determining the
appropriate clinical privileges that should be granted based on a
physician's clinical competence. VA implemented our recommendation by
issuing a policy on October 2, 2007, that elaborated on the sources of
physician performance information and the types of information that
could be collected outside of VA medical facilities' quality assurance
programs. In addition, in July 2007, VA officials told us that they
were in the process of implementing online training programs on
physician performance information to help implement our recommendation.
The training will be mandatory for all VA medical facility clinical
service chiefs and medical staff leaders responsible for the assessment
and oversight of the privileging process and must be completed by
January 31, 2008.
VA also implemented our recommendation that it enforce its requirement
that VA medical facilities report information on any paid VA
malpractice claims involving their physicians to VA's Office of
Medical-Legal Affairs within 60 days after being notified of a paid
claim. In June 2006, VA's Office of Medical-Legal Affairs began
notifying network and VA medical facility directors of delinquencies in
reporting this information by the medical facilities. If a medical
facility's delinquency in reporting extends longer than 90 days, VA
requires the Office of Medical-Legal Affairs to inform not only network
and VA medical facility directors but also VA's central office of the
delinquency. Because VA's Office of Medical-Legal Affairs reviews
information on paid malpractice claims involving VA physicians to
determine whether the physicians delivered substandard care, when VA
medical facilities do not submit relevant malpractice claim information
to this office, medical facility clinical service chiefs may make
privileging decisions without complete information about substandard
care provided by physicians.
Further, VA implemented our recommendation that it instruct VA medical
facilities to establish internal controls to ensure the accuracy of
their privileging information. Internal controls help ensure that VA
medical facility officials have accurate clinical privileging
information and that physicians are not practicing at the facility with
expired clinical privileges. To address our recommendation, VA first
asked network directors to report on how they tracked the privileging
status of VA physicians. In response to a VA memorandum sent on May 16,
2006, network directors provided a report indicating that their medical
facilities had one or more mechanisms in place to identify physicians
who were currently privileged at their facilities and to track whether
their privileges have expired. In addition, VA instructed its network
directors to monitor the internal controls at their facilities that
ensure that VA medical facilities have accurate clinical privileging
information and that physicians are not practicing with expired
clinical privileges.
Mr. Chairman, this concludes my prepared remarks. I will be pleased to
answer any questions you or other members of the committee may have.
Contacts and Acknowledgments:
For further information regarding this testimony, please contact
Randall B. Williamson at (202) 512-7114 or williamsonr@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this testimony. Marcia Mann, Assistant
Director; Mary Ann Curran; Christina Enders; Krister Friday; Lori
Fritz; Rebecca Hendrickson; and Jason Vassilicos also contributed to
this statement.
[End of section]
Footnotes:
[1] GAO, VA Health Care: Selected Credentialing Requirements at Seven
Medical Facilities Met, but an Aspect of Privileging Process Needs
Improvement, GAO-06-648 (Washington, D.C.: May 25, 2006), and VA Health
Care: Patient Safety Could be Enhanced by Improvements in Employment
Screening and Physician Privileging Practices, GAO-06-760T
(Washington, D.C.: June 15, 2006).
[2] State licenses are issued by offices in states, territories, or the
District of Columbia, collectively referred to as state licensing
boards.
[3] NPDB includes information on medical malpractice claims that are
paid, but does not include information on ongoing claims.
[4] Clinical services may include surgery, medicine, and radiology.
[5] Reduction of privileges may include restricting or prohibiting a
physician from performing certain procedures or prescribing certain
medicines. Revocation of privileges refers to the permanent loss of all
clinical privileges at that facility.
[6] At some VA medical facilities, the professional standards board and
the medical executive committee represent the medical staff, have the
same members, and perform the same functions so are considered to be
one committee. If the committees are separate, the professional
standards board generally consists of three to five physician peers and
the medical executive committee generally consists of all facility
clinical service chiefs.
[7] Support granting clinical privileges means that the clinical
privileges previously held by the physician will be maintained and
newly requested clinical privileges will be added.
[8] VA requires its medical facilities to have a quality assurance
program. In general, the VA quality assurance program consists of
specified systematic health care reviews carried out by or for VA for
the purpose of improving the quality of medical care or the utilization
of health care resources in VA facilities. See 38 C.F.R. § 17.500
(2005). These programs collect data on various clinical process and
outcome measures involving physicians and other types of practitioners.
The measures may include a surgeon's complication rate or a physician's
prescribing of medications. Medical facility officials use these
measures to look for undesirable patterns and trends in performance.
[9] 38 U.S.C. § 5705 (2000).
[10] See Department of Veterans Affairs, VHA Handbook, 1100.19
(Washington, D.C.: Mar. 6, 2001).
[11] Findings for the credentialing and privileging requirements cannot
be generalized to the facility being reviewed because of the sample
size.
[End of section]
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