January 6, 2010

VA Health Care: Improved Oversight and Compliance Needed for Physician Credentialing and Privileging Processes

Virginia has policies to ensure that physicians have appropriate qualifications and clinical abilities through the processes of credentialing, privileging, and continuous monitoring of performance. Results of a VA investigatory report in 2008 cited deficiencies in the Marion, Illinois, VA medical center's (VAMC) credentialing and privileging processes and oversight of its surgical program. This report, created by the United States Government Accountability Office, examines VA's policies and guidance to help ensure that information about physician qualifications and performance is accurate and complete, VAMCs' compliance with selected VA credentialing and privileging policies, and their implementation of VA policies to continuously monitor performance. GAO reviewed VA's policies, interviewed VA officials, and reviewed a judgmental sample of 30 credentialing and privileging files at each VAMCs. GAO selected the files to ensure inclusion of highly paid specialties, newly hired physicians, and other physician characteristics.