For reappointment only, 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. VA Has Taken Steps to Improve Employment Screening Requirements, but Gaps Remain

VA has taken steps to improve employment screening of its health care  practitioners by partially implementing each of the four recommendations  made in our March 2004 report; however, gaps still remain in VA’s health  care practitioner screening requirements. To address our recommendation  that VA facility officials contact state licensing boards and national  certifying organizations to verify all licenses and certificates held by all VA  health care practitioners, VA expanded its verification requirement to  include licenses and certificates for all prospective hires but did not  extend this requirement to include all practitioners currently employed by  VA. For those currently employed, such as nurses and pharmacists, VA  only required facility officials to physically inspect one license of a  practitioner’s choosing. VA Facilities Did Not Comply with Employment Screening Requirements for Practitioners

For the seven VA facilities we visited to determine compliance with  employment screening requirements for practitioners, we found poor  compliance with four of the five requirements we selected for review. Physician Files at Facilities Demonstrated Compliance with Almost All Selected Credentialing and Privileging Requirements; Not All Facilities Submitted Paid Malpractice Claim Information in a Timely Manner

We found that the physician files at the facilities we visited demonstrated  compliance with four VA credentialing and four privileging requirements  we reviewed. Officials at six  medical facilities told us that they used performance information to  support the granting of clinical privileges requested by their physicians,  but collected all or most of this information through facility quality  assurance programs. When VA medical facilities do not submit all relevant claim information to  the Office of Medical-Legal Affairs, determinations on substandard care  are not available to facility officials when they make privileging decisions. VA Has Not Established Internal Controls to Help Ensure the Accuracy of Facilities’ Privileging Information

VA has not required its medical facilities to establish internal controls to  help ensure that privileging information managed by medical staff  specialists is accurate. One facility we 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. Our reports include the following four recommendations that VA should  implement to help ensure patient safety:    expand the human resource management oversight program to include a  review of VA facilities’ compliance with employment screening  requirements for all types of practitioners,    provide guidance to medical facilities on how to collect individual  physician performance information in accordance with VA’s credentialing  and privileging requirements to use in medical facilities’ privileging  processes,    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 physician privileging information. Appendix I: March 2004 Report Recommendations and VA Screening, Credentialing, and Privileging Requirements

In our March 2004 report, VA Health Care: Improved Screening of  Practitioners Would Reduce Risk to Veterans, we made four  recommendations to address the gaps we identified in VA’s employment  screening requirements and the noncompliance we found at the four  medical facilities we visited. We selected two other requirements because VA  implemented these since March 2004 to improve its employment screening  of practitioners. Verify that all state medical licenses held by physicians are valid.
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.