	Selected VA Medical Centers’ Reviews of Providers’ Clinical Care Were Not Always Documented or Timely

We found that from October 2013 through March 2017, the five selected  VA medical centers required reviews of a total of 148 providers’ clinical  care after concerns were raised about their care, but officials at these  medical centers could not provide documentation to show that almost half  of these reviews were conducted. Specifically,  of the 148 providers, the VA medical centers did not initiate reviews of 16  providers for 3 months, and in some cases, for multiple years, after  concerns had been raised about the providers’ care. Second, VHA’s oversight of the reviews of providers’ clinical care is  inadequate. Under VHA policy, networks are responsible for  overseeing the credentialing and privileging processes at their  respective VA medical centers. Without adequate documentation and timely completion of reviews of  providers’ clinical care, VA medical center officials lack the information  they need to make decisions about providers’ privileges, including  whether or not to take adverse privileging actions against providers. To  address these shortcomings, we recommended that VHA 1) require  documentation of all reviews of providers’ clinical care after concerns  have been raised, 2) establish a timeliness requirement for initiating such  reviews, and 3) strengthen its oversight by requiring networks to oversee  VA medical centers to ensure that such reviews are documented and  initiated in a timely manner. Selected VA Medical Centers Did Not Report All Providers to the NPDB or to State Licensing Boards as Required

We found that from October 2013 through March 2017, the five VA  medical centers we reviewed had only reported one of nine providers  required to be reported to the NPDB under VHA policy. These nine  providers either had adverse privileging actions taken against them or  resigned or retired while under investigation before an adverse privileging  action could be taken. None of these nine providers were reported to  state licensing boards as required by VHA policy. This  misinterpretation of VHA policy meant that the NPDB and the state  licensing boards in other states where the provider held licenses were  not alerted to concerns about the provider’s clinical practice. We found, for example, that network officials were unaware of situations in which VA medical center officials failed to report providers to the NPDB. We concluded that VHA lacks reasonable assurance that all providers who should be reported to these entities are reported. We also found that a provider who was not  reported as required to the NPDB during the period we reviewed had their  privileges revoked 2 years later by a non-VA hospital in the same city for  the same reason the provider was under investigation at the VA medical  center. To improve VA medical centers’ reporting of providers to the NPDB and  state licensing boards and VHA oversight of these processes, we  recommended that VHA require its networks to establish a process for   overseeing VA medical centers to ensure they are reporting to the NPDB  and to state licensing boards and to ensure that this reporting is timely.
Why GAO Did This Study

This testimony summarizes the information contained in GAO's November 2017 report, entitled VA Health Care: Improved Policies and Oversight Needed for Reviewing and Reporting Providers for Quality and Safety Concerns ( GAO-18-63 ).

What GAO Found

Department of Veterans Affairs (VA) medical center (VAMC) officials are responsible for reviewing the clinical care delivered by their privileged providers—physicians and dentists who are approved to independently perform specific services—after concerns are raised. The five VAMCs GAO selected for review collectively required review of 148 providers from October 2013 through March 2017 after concerns were raised about their clinical care. GAO found that these reviews were not always documented or conducted in a timely manner. GAO identified these providers by reviewing meeting minutes from the committee responsible for requiring these types of reviews at the respective VAMCs, and through interviews with VAMC officials. The selected VAMCs were unable to provide documentation of these reviews for almost half of the 148 providers. Additionally, the VAMCs did not start the reviews of 16 providers for 3 months to multiple years after the concerns were identified. GAO found that VHA policies do not require documentation of all types of clinical care reviews and do not establish timeliness requirements. GAO also found that the Veterans Health Administration (VHA) does not adequately oversee these reviews at VAMCs through its Veterans Integrated Service Networks (VISN), which are responsible for overseeing the VAMCs. Without documentation and timely reviews of providers' clinical care, VAMC officials may lack information needed to reasonably ensure that VA providers are competent to provide safe, high quality care to veterans and to make appropriate decisions about these providers' privileges.
GAO also found that from October 2013 through March 2017, the five selected VAMCs did not report most of the providers who should have been reported to the National Practitioner Data Bank (NPDB) or state licensing boards (SLB) in accordance with VHA policy. The NPDB is an electronic repository for critical information about the professional conduct and competence of providers. GAO found that
selected VAMCs did not report to the NPDB eight of nine providers who had adverse privileging actions taken against them or who resigned during an investigation related to professional competence or conduct, as required by VHA policy, and
none of these nine providers had been reported to SLBs.
GAO found that officials at the selected VAMCs misinterpreted or were not aware of VHA policies and guidance related to NPDB and SLB reporting processes resulting in providers not being reported. GAO also found that VHA and the VISNs do not conduct adequate oversight of NPDB and SLB reporting practices and cannot reasonably ensure appropriate reporting of providers. As a result, VHA's ability to provide safe, high quality care to veterans is hindered because other VAMCs, as well as non-VA health care entities, will be unaware of serious concerns raised about a provider's care. For example, GAO found that after one VAMC failed to report to the NPDB or SLBs a provider who resigned to avoid an adverse privileging action, a non-VA hospital in the same city took an adverse privileging action against that same provider for the same reason 2 years later.