From the U.S. Government Accountability Office, www.gao.gov Transcript for: Ensuring Quality Medical Care from VA Providers Description: Nearly 40,000 physicians and dentists have privileges to independently perform specific services in the Department of Veterans Affairs' 170 medical centers. What does the VA do to ensure that all these health care professionals are providing safe, high-quality care to veterans? Related GAO Work: GAO-18-63: VA Health Care: Improved Policies and Oversight Needed for Reviewing and Reporting Providers for Quality and Safety Concerns Released: November 2017 [ Sharon Silas: ] The VA has a responsibility to identify and report providers with serious performance issues. [ Jacques Arsenault: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Jacques Arsenault. Nearly 40,000 physicians and dentists have privileges to provide medical care in the Department of Veterans Affairs' 170 medical centers. What does the VA do to ensure that all these healthcare professionals are providing safe, high-quality care to veterans? GAO's new report looks at VA's oversight of the doctors who have privileges in their medical centers. I sat down with Sharon Silas, an acting director in our Health Care team, to talk about it. Looking at your report, it seems like VA has a system in place to make sure that doctors who treat veterans are providing safe and high-quality care, but it seems like the system may not be working as it should. Can you tell me a little more about what you found? [ Sharon Silas: ] VA does have a process in place, but what we found is the process is not working very well. The VA Medical Centers are responsible for reviewing provider care when concerns have been raised about unsafe care or performance issues, and these concerns can be identified in a couple of different ways. The VA does do some ongoing monitoring of providers, where the providers are assessed against benchmarks twice a year, but they also could identify concerns through patient complaints or, for example, through a malpractice suit. [ Jacques Arsenault: ] And so, what is VA supposed to do when a complaint does come in, or something is issued during the monitoring? [ Sharon Silas: ] When these concerns are identified, there are a couple of different types of reviews, called focused reviews, that VA can do. The first type is a prospective review. In this review, the provider continues to provide care, and they get to demonstrate improvements in their performance. There's also a retrospective review. Retrospective review is when the VA officials will look at the past history of the provider, and look to identify any concerns or issues with care that maybe hadn't been previously identified. Lastly, there's a comprehensive review. A comprehensive review is also retrospective, but it is conducted by a panel of experts, and is a little more detailed. Even though VA can do any of these reviews in any combination, what we found is for the 148 provider reviews that were included in our study, the VA was only able to provide documentation for just over half of the reviews, and in some instances, it wasn't clear the reviews were conducted at all. [ Jacques Arsenault: ] So, based on their records, we don't even know, among that 148, if they even looked at all those concerns. [ Sharon Silas: ] Yes, in some instances, yes. [ Jacques Arsenault: ] So, when they do review, if they find that a doctor isn't providing safe or high-quality care, what is VA supposed to do, then? [ Sharon Silas: ] Well, if the review substantiated any of the serious concerns that have been raised, the VA can limit or revoke the provider's privileges to practice at that VA Medical Center. If they decide to take those actions, then the VA is required to report those actions to the National Practitioner Data Bank, which is a repository of information on the providers, and the state medical licensing boards. [ Jacques Arsenault: ] And, do we know if that's happening? [ Sharon Silas: ] Of the 148 providers, the provider reviews that we included in our study, the VA revoked privileges for 9 of those providers, and then an additional 4 providers resigned during the course of the review, once they were notified that their privileges would be limited or could be revoked. What was really interesting, though, was for those 13 providers, the VA only reported one of them to the National Practitioner Data Bank, and none of those providers were reported to the state licensing boards. [ Jacques Arsenault: ] So, if they're supposed to be reporting to both of those for any doctors who they're, you know, sanctioning or removing or limiting privilege, do we know, why are they not following through on that? [ Sharon Silas: ] Well, what we found in our study is that there's a couple of things going on. At the medical-center level, there seems to be some confusion about the policy to report to the National Practitioner Data Bank, and to the state medical licensing boards. It seemed that the medical center officials were not clear on when to report, and under what circumstances. We also found that the VA policy also does not require the VA networks to oversee the medical centers' reporting of the providers, and so what you have, then, is that the medical centers are not consistently reporting to either the National Practitioner Data Bank or the state medical licensing boards. [ Jacques Arsenault: ] So, what are the consequences, then, if it's not reported out to these other groups? [ Sharon Silas: ] What we found in our study was that by failing to report providers, the VA was basically creating an environment where these poor performers could go and practice in other VA Medical Centers, or even outside the VA Healthcare System. In one particular example, we found a provider who had resigned to avoid losing their privileges, and that same provider also had their privileges revoked at a non-VA hospital in the same city 2 years later. [ Background Music ] [ Jacques Arsenault: ] That seemed like a really big problem. I definitely wanted to know what Sharon's team was recommending to address it. [ Sharon Silas: ] We have a number of recommendations that we made in this report. We recommended for the VA to document all of their focused reviews, and to have a timeliness requirement for those reviews. We also made recommendations that the VA networks properly oversee the medical centers' conducting of these reviews, but also the reporting out to the National Practitioner Data Bank and the state medical licensing boards. [ Jacques Arsenault: ] And finally, what would you say is the bottom line of this report? [ Sharon Silas: ] Well, the bottom line is, is that the VA has a responsibility to identify and report providers with serious performance issues. To not do so could put veterans within the VA healthcare system, and also the general public, at risk to receiving unsafe medical care. [ Background Music ] [ Jacques Arsenault: ] Thanks for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Jacques Arsenault: ] For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.