Physicians who work at VA medical facilities are required to hold at least  one current and unrestricted state medical license. 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. 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. Figure 1 illustrates VA’s credentialing process. 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. 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. Figure 2 illustrates VA’s  privileging process. VA has another requirement that is related to the renewal of physicians’  clinical privileges. 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. 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. 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.
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 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

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.