By Sandra Basu
WASHINGTON — Reporting the results of an investigation begun after an Army physician opened fire and shot more than 40 people at Fort Hood in 2009, the Government Accountability Office (GAO) says the military services need to do a better job of complying with physician and privileging requirements.
First responders use a table as a stretcher to transport a wounded soldier to a waiting ambulance at Fort Hood Nov. 5, 2009. U.S. Army photo by Sgt. Jason R. Krawczyk.
DoD has protocols in place to check physician credentials, and the services have their own procedures and processes to ensure that the MTFs meet the DoD requirements. A GAO investigation found, however, that the military services’ requirements in some cases are inconsistent with DOD’s and each other’s requirements.
Furthermore, the GAO investigation found that DoD “lacks a systematic process” to address inconsistencies across requirements, to coordinate revisions to the requirements and to “achieve its goal of standardizing physician credentialing and privileging requirements across the MHS.”
“Such differences may result in MTF noncompliance with requirements that DoD deems important. They may also create challenges for ensuring that all requirements are met for physicians from one military service who are working at an MTF managed by another service,” the GAO report stated.
GAO Examines Credentialing Compliance
GAO was asked to examine DoD’s physician credential and privileging requirements and whether MTFs were complying fully with these requirements after an independent investigation found discrepancies between Army MAJ Nidal Hasan’s documented performance in official records and his actual performance during his medical training, residency and fellowship in an Army MTF. Nasan was accused of killing 13 people and injuring several others at Fort Hood in November 2009.
The events at Fort Hood and the findings of the subsequent investigation raised questions about “whether the military services’ individual networks of MTFs are fully complying with DOD’s physician credentialing and privileging requirements and appropriately implementing credentialing and privileging processes,” the GAO report stated.
As part of its review, GAO looked at a sample of 150 Army physician credential files and interviewed staff at five Army MTFs to see whether the MTFs were in compliance with Army physician and credentialing requirements.
GAO found that the MTFs it examined did not comply fully with certain Army physician credentialing and privileging requirements. The report stated that, for 34 of the 150 credential files GAO reviewed, the MTF had not documented proper verification of every state medical license physicians had held at the time the MTF granted privileges.
Furthermore, seven of these 34 credential files lacked this documentation for the physician’s current medical license. In addition, the credential files did not consistently contain required documents to support the physician’s clinical competence, including peer recommendations and performance assessments.
“Based on our review of 150 credentials files at the five Army MTFs we selected for our review, we found that none of the five Army MTFs fully complied with certain Army physician credentialing and privileging requirements,” the report stated.
Army Medical Command officials told U.S. Medicine in a statement that it “values the GAO’s review” and is “assessing the report’s concerns by implementing a systematic and comprehensive review” of its processes at all 35 Army facilities in which professionals are credentialed.
In addition, Army Medical Command officials said all Army MTFs are fully accredited by The Joint Commission and that they do not believe patient care was compromised as a result of the issues GAO identified.
“While we are confident that the variances identified in the GAO report did not result in harm or substandard healthcare for our soldiers or beneficiaries, we are determined to reexamine our credentialing and privileging processes and establish oversight to ensure a top-quality healthcare team,” they noted in a statement.
The other services also were singled out in the report. For example, DoD requires MTFs to verify peer recommendations with the primary source. While the Army and Navy follow this protocol, the Air Force does not specify that the verification must be with the primary source. The GAO investigators wrote that, as a result, “Air Force MTFs may therefore lack assurance that the peer recommendations they have received for a physician are authentic.”
The report also noted that Navy and Air Force officials from the agencies that oversee physician credentialing and privileging requirements for their services acknowledged that, like the Army, “they lack a process for reviewing individual MTFs’ credentials files and that some of their documentation requirements are unclear.”
The GAO offered several recommendations, including that DoD should direct the assistant secretary of defense for health affairs and the surgeons general of the military services to establish a process across DoD to coordinate all current and future efforts to revise physician credentialing and privileging requirements for consistency across the services.
DoD officials stated in a letter contained with the report that the assistant secretary of defense for health affairs is “preparing an updated policy for to establish a single business process for risk management and credentialing and privileging.”
“All three services and the Joint Task Force National Capital Region Medical fully support the development of a single business process for MHS credentialing and privileging. Included with the redesign, we have identified best practices and will apply them across the MHS in order to standardize the credentialing and privileging process and eliminate inconsistencies,” he wrote.
The GAO stated in its report that, while DoD had expressed agreement with the recommendations, the agency did not provide “sufficient detail” to determine “how fully the agency’s planned actions will address the intent of the recommendations” or “establish timeframes for any of the actions it identified” to address the recommendations.
The report, “DoD Health Care: Actions Needed to Help Ensure Full Compliance and Complete Documentation for Physician Credentialing and Privileging,” can be found at http://www.gao.gov/products/GAO-12-31.