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What did the GAO find?
The Defense Health Agency is responsible for ensuring the quality and safety of health care provided by private providers at its military medical facilities. However, GAO found that four selected facilities and the Defense Health Agency did not always follow the agency’s clinical quality management procedures because they were unclear.
- Recognition and Privilege. The GAO reviewed documents submitted to 100 providers from four selected institutions and found that the institutions did not always comply with the Defense Health Agency’s credentialing and credentialing process — the process of verifying that a provider has the appropriate qualifications and skills to provide certain health care services. For example, for about one-sixth of evaluated providers, the facilities did not verify all medical licenses before granting privileges. In addition, for nearly half of the providers reviewed, the facilities did not receive clinical referrals from appropriate individuals such as the program director as required. The GAO said this is because it is unclear which providers must have clinical references.
- Stress-based assessments. The four selected institutions jointly conducted 20 focused assessments to address clinical performance concerns for individual providers. GAO’s review found that these facilities do not always comply with requirements. For example, in about half of these reviews, facilities did not develop metrics to assess whether providers were adequately addressing the concerns raised. GAO found that noncompliance was partly due to unclear procedures, such as inconsistent wording of these reviews.
- Patient safety incidents resulting in compensation. The GAO found that the Defense Health Agency does not always follow its own standards for reviewing patient safety incidents. Patient safety incidents, such as the misdiagnosis of a life-threatening condition, may involve compensation for potential harm to a patient. The four selected facilities had 12 arrangements that reimbursed patients or their families. Notably, the Defense Health Agency’s evaluations of nine of these incidents exceeded the time frame required for those evaluations. In addition, the Defense Health Agency did not report the providers involved in those nine events to the national database as required.
GAO also found that Defense Health Agency facilities did not adequately monitor compliance with clinical quality management practices. Beginning in May 2022, the Defense Health Agency will monitor compliance with some certification and exclusivity requirements by conducting database reports of expired credentials, but will not monitor compliance with other requirements, such as certain job performance reviews. Defense Health Agency officials told the GAO that they have plans to conduct focused assessments of facilities and monitor patient safety incidents, but have not yet implemented those plans.
Why did the GAO do this study?
Since 2014, Congress and the Department of Defense (DOD) have taken steps to strengthen patient safety in the military health system. As part of those efforts, Congress mandated the Defense Health Agency, an agency within the DOD, to assume responsibility for facility management for the military departments. This responsibility includes ensuring that individual providers are qualified and competent to provide safe and high-quality care to patients.
Congress included a statutory provision for the GAO to review the Defense Health Agency’s clinical quality management procedures. This report examines facilities and the Defense Health Agency’s monitoring of compliance with these procedures and the Defense Health Agency. GAO reviewed documents from the four institutions selected for location and Department of Defense diversity. GAO also reviewed the Defense Health Agency’s clinical quality management procedures and interviewed relevant Defense Health Agency officials about these procedures and related monitoring efforts. GAO evaluated the procedures and monitoring efforts using the Federal Internal Control Standards.
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