A new report from the Government Accountability Office found that the Department of Veterans Affairs is failing to keep proper tabs on medical providers per agency policy. The GAO findings were based on reviews of 148 instances of complaints against VA medical providers at five hospitals from 2013 to 2017.
Of the five VA medical centers it reviewed, GAO found that in 8 out of 9 cases, they failed to report providers who weren’t meeting healthcare standards to the National Practitioner Data Bank (NPDB), and all 9 were not reported to State Licensing Boards (SLBs). Furthermore, the 1 provider who was reported to the NPDB for an adverse privileging action was reported 136 days after all internal VA appeals were complete, far beyond the 15 day reporting requirement.
VA policy requires its medical centers to alert certain entities if there are serious concerns with regard to a provider’s clinical performance.
The medical centers reviewed by GAO also were sorely lacking in required documentation.
GAO found that the medical centers collectively required reviews of 148 providers’ clinical care after concerns were raised from October 2013 through March 2017, but officials were unable to provide documentation that almost half of these reviews were conducted. GAO also found that all five of the medical centers lacked at least some documentation of the reviews they said were conducted, and in some cases the required reviews were not conducted at all.
This is inconsistent with internal control standards for monitoring and documentation which state that management should conduct and document separate evaluations, when necessary.
The GAO report also noted that reviews were not conducted in a timely manner per VA requirements.
Specifically, of the 148 providers, the VA medical centers’ initiation of reviews of 16 providers’ clinical care was delayed by more than 3 months, and in some cases for multiple years, after the concern was raised.
At one medical center, service chiefs were not instructed to conduct reviews of 14 providers until 4 to 13 months after these providers met the VAMC’s peer review trigger. Before the service chiefs were notified of the concerns, 3 of these providers had at least one additional concerning episode of care — that peer reviewers judged would have been handled differently by most experienced providers — identified through the peer review process.
GAO noted that the lack of documentation could be a serious problem for the VA: “Without documentation and timely reviews of providers’ clinical care, [VA] 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,” wrote GAO in its report.
GAO ultimately made 4 recommendations to the VA based on its findings, each of which the agency said it agreed with:
- The Under Secretary for Health should specify in VHA policy that reviews of providers’ clinical care after concerns have been raised should be documented, including retrospective and comprehensive reviews.
- The Under Secretary for Health should specify in VHA policy a timeliness requirement for initiating reviews of providers’ clinical care af ter a concern has been raised.
- The Under Secretary for Health should require Veterans Integrated Service Network (VISN) officials to oversee medical center reviews of providers’ clinical care after concerns have been raised, including retrospective and comprehensive reviews, and ensure that VISN officials are conducting such oversight with the required standardized audit tool. This oversight should include reviewing documentation in order to ensure that these reviews are documented appropriately and conducted in a timely manner.
- The Under Secretary for Health should require VISN officials to establish a process for overseeing medical centers to ensure that they are reporting providers to the NPDB and SLBs, and are reporting in a timely manner.
VA Health Care: Improved Policies and Oversight Needed for Reviewing and Reporting Providers for Quality and Safety Concerns