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GAO Calls for Stronger Credentialing, Privileging Oversight at Facilities

Janice Simmons, for HealthLeaders Media, January 8, 2010

The Government Accountability Office (GAO), after reviewing credentialing, privileging, and performance monitoring procedures at several Department of Veterans Affairs (VA) medical centers, has called for several areas of improvement among those facilities.

GAO's interest began when seven out of 180 patients died—a rate that was far greater than expected—between October 2006 and March 2007 at a VA medical center in Marion, IL. This prompted an investigation by the VA Office of Inspector General (OIG), which later issued a report that identified numerous deficiencies related to credentialing, privileging, and monitoring surgical care.

At the time, the VA OIG found many instances in which physicians had privileges to perform procedures without evidence of competence to perform the procedures, and that the surgical program was expanded to include complex surgical procedures—even though sufficient clinical support services, such as 24 hour respiratory therapy, pharmacy, and radiology, were not available at the medical center.

Based on these events, questions were raised about physician credentialing and privileging processes at other VA facilities and whether they were performing surgical procedures backed by clinical support services. The VA OIG recommended that VA make improvements and policy changes related to these processes, and implement an oversight mechanism to ensure that appropriate clinical support services are available for all surgical procedures.

To find out if changes were being implemented, GAO visited six VA medical centers across the country. It interviewed chief medical officers and reviewed physician files—looking for evidence of omissions by physician applicants related to medical licenses, malpractice, and gaps in background greater than 30 days, according to GAO.

GAO found that the problems at the six facilities did not mirror the extent of the problems reported by investigators at the Marion VA Medical Center. However, GAO added that the staff at the six facilities did not consistently follow VA's credentialing and privileging policy requirements selected for review.

As an example, GAO found that 29 of the 180 credentialing and privileging files reviewed lacked proper verification of state medical licensure. Also, the medical centers did not identify instances when physicians appeared to have omitted required information on their applications: For instance, GAO identified 21 files where physicians did not disclose required malpractice information, which the facilities did not detect.

GAO also found that the VA policies often lacked sufficient internal controls—such as specifying how compliance should be assessed—to identify and correct problems with the medical centers' noncompliance with credentialing and privileging policies.

To address these areas, GAO calls for better oversight by recommending that the Secretary of Veterans Affairs direct the Undersecretary for Health to take the following actions:

  • Require development of a formal oversight process that reviews credentialing and privileging files and the information used to support reprivileging of physicians. This oversight process should include feedback to VA medical center officials about the proper use of legally protected performance information—if necessary, GAO said.
  • Update VetPro, VA's Web based credentialing database, to more effectively display physician credentialing information. Specifically, the VA should simplify and clarify questions related to malpractice and licensure, GAO added.
  • Collect more information about the state medical boards' policies on the release of information.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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