Title: DOD Efforts to Ensure Quality of Care at Military Health
Facilities 

Description: The Department of Defense (DOD) provides health care and
dental services to military servicemembers and their families at
hundreds of health facilities and clinics. Since 2014, Congress and the
DOD have taken steps to strengthen patient safety at these facilities,
including steps to ensure health care providers are qualified to deliver
care. However, there have been incidents that resulted in serious safety
issues for patients. We find out more from GAO's Sharon Silas.

Related GAO Work: GAO-22-104668, Military Health Care: Improved
Procedures and Monitoring Needed to Ensure Provider Qualifications and
Competence

Released: August 2022

[Music]

[Sharon Silas:] In 2014, there were concerns raised about the military
services' ability to oversee provider quality of care issues. 

[Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for
news and information from the U.S. Government Accountability Office. I'm
your host--Holly Hobbs. The Department of Defense provides health care
and dental services to military servicemembers and their families at
hundreds of health facilities and clinics. DOD's Defense Health Agency
oversees the quality of this care, including ensuring providers are
qualified. However, there have been incidents that resulted in serious
safety issues for patients. Today, we'll find out more from Sharon
Silas, an expert on military health care issues and a director in our
Health Care Team. Thanks for joining us. 

[Sharon Silas:] Thanks for having me, Holly.

[Holly Hobbs:] So, Sharon, what were the concerns that lead us to review
DOD's oversight of health care providers?

[Sharon Silas:] Sure. So in 2014, there were concerns raised about the
military services' ability to oversee provider quality of care issues.
And so in 2019 Congress required DOD to transfer management of the
military health facilities from the military services to the Defense
Health Agency. And then as part of that, the Defense Health Agency
issued standardized procedures that are really intended to ensure that
the individual providers are qualified and competent to deliver safe,
high quality care to patients across the services. Then in 2020,
Congress required GAO to review how the DOD's Defense Health Agency
monitors provider quality care issues.

[Holly Hobbs:] So for our review of DHA's oversight, what did we look
at?

[Sharon Silas:] So we looked at three processes for overseeing provider
quality care issues. The first one was credentialing. So this is a
process where providers are on-boarded at military health facilities,
and then the facility staff review their skills and qualifications,
background, to ensure they are competent to provide care to patients. We
also looked at a process for focused evaluations that are conducted when
a provider's delivery of care is found deficient or there's concerns
raised. And so then the providers are closely monitored to improve their
skills. And then we also looked at the process for overseeing patient
safety events that could have resulted or did result in patient harm.

[Holly Hobbs:] So for those three things, we looked at, can you tell us
what we found? Maybe we could start with credentialing. 

[Sharon Silas:] Sure. For the credentialing, we found that the military
services weren't always following their credentialing procedures. We
reviewed ten different credentialing procedures and found cases of
non-adherence across all of those. So, for example, we found that the
facility staff, when they were doing the credentialing reviews, they
didn't always verify that the provider's licenses were valid. 

[Holly Hobbs:] What about evaluation of providers? 

[Sharon Silas:] For the  focused evaluation, we found that the military
health facilities did not consistently adhere to the procedures for the
evaluations. So, for example, facilities were inconsistent in
documenting key elements that are needed to determine if a provider had
improved in their delivery of care.

[Holly Hobbs:] And you said we also looked at how the Defense Health
Agency reviewed events involving patient's safety. What did we find
there? 

[Sharon Silas:] We found deficiencies in the Defense Health Agency's
monitoring. So, for example, the Defense Health Agency wasn't completing
the reviews of these patient safety events and reporting them within the
required time frames. For patient safety events, we looked at 12 cases,
and half of the 12 cases were incomplete and had exceeded their 270 day
requirement for completing and reporting those. 

[Holly Hobbs:] But DOD has taken some steps to address safety concerns.
What all have they done? 

[Sharon Silas:] So the officials from the Defense Health Agency told us
that they had plans to update and clarify procedures across all three of
those processes that we looked at, and that they were going to do that
over the next year. They also told us that they were planning to develop
some tools to help with the monitoring of the military health facilities
to ensure that they were adhering to those procedures. But we found that
they didn't have any specifics or details of those plans.

{MUSIC}

[Holly Hobbs:] Sharon just told us that during our review of the Defense
Health Agency, we found deficiencies in how the agency monitors the
quality of its health care providers. And that while DHA says it is
taking steps to address those deficiencies, it didn't have a detailed
plan for doing so. So, Sharon, given what we found, what additional
actions should the DOD and the Defense Health Agency take to strengthen
their oversight of health care providers? 

[Sharon Silas:] We are making two recommendations to DOD's Defense
Health Agency. They cover all three of the processes that we looked at
because we found deficiencies across all of them. The first
recommendation is that we're recommending that the Defense Health Agency
revise and clarify procedures across all three processes that we
reviewed. And we're also making a recommendation that the Defense Health
Agency implement monitoring of the military services adherence to those
procedures and ensure the facilities are following them. 

[Holly Hobbs:] And last question, what's the bottom line of this report?

[Sharon Silas:] So, in order for DOD to ensure providers are delivering
quality care to military service members and their families--and that any
concerns about the quality care they are receiving are being effectively
address--DHA needs to ensure that clinical quality procedures are clear
and are being properly followed.

[Holly Hobbs:] That was Sharon Silas talking about GAO's recent review
of DOD's oversight of quality of health care provided in military
facilities. Thanks for your time, Sharon. 

[Sharon Silas:] Thanks, Holly. 

[Holly Hobbs:] And thank you for listening to the Watchdog Report. To
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