Review of VISN 21 Clinical Resource Hub Sleep Medicine Physician Privileging

Report Information

Issue Date
Report Number
25-00302-243
VISN
21
State
California
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Report Topic
Clinical Care Services Operations
Medical Staff Privileging Credentialing
Major Management Challenges
Healthcare Services
Leadership and Governance
Recommendations
5
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate allegations that sleep medicine physicians at the VA Sierra Pacific Network, Veterans Integrated Service Network (VISN) 21 Clinical Resource Hub (CRH) treated patients without having sleep medicine privileges. The OIG found noncompliance with VHA Directive 1100.21(1) and VHA Credentialing and Privileging Office Standard Operating Procedure – P11, “Lapse of Privileges.”

The OIG substantiated that two VISN 21 CRH sleep medicine physicians treated patients during a lapse in their sleep medicine privileges. Inadequate oversight by the San Francisco Healthcare System (system) Chief of Staff and administrative deficiencies by the medical staff office contributed to the lapse. The two physicians maintained privileges in areas other than sleep medicine and should have been removed from patient care while their care was reviewed. The OIG did not learn of patient harm or receive complaints related to patient harm.

The OIG determined that a lack of national guidance for sleep medicine privileges contributed to a lack of clarity among sleep medicine physicians and CRH leaders about privileging sleep medicine physicians. Although aware of sleep medicine physicians’ concern following the standardization of sleep medicine privileges, the VISN 21 CRH director did not resolve confusion among sleep medicine physicians regarding the impacts of privileging changes, including potential disruptions in sleep medicine services due to the lack of other specialty privileges. 

The OIG made five recommendations. The Acting Under Secretary for Health agreed to providing detailed written guidance regarding privileging sleep medicine physicians. The VISN reported educating VISN and system leaders. The System Director confirmed monitoring of CRH sleep medicine practitioners privileges, planning to provide sleep medicine practitioners with core privileges and education regarding referring veterans to other specialists, and notifying medical center directors and chiefs of staff of privileging and practice changes.
 

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The San Francisco Healthcare System Director confirms the Sierra Pacific Veterans Integrated Service Network Clinical Resource Hub sleep medicine licensed independent practitioners are privileged in accordance with policy and monitors for compliance.

No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Sierra Pacific Veterans Integrated Service Network Director ensures Sierra Pacific Veterans Integrated Service Network leaders and San Francisco Healthcare System leaders are educated on Veterans Health Administration policies regarding actions required following licensed independent practitioners’ lapse in privileges.

No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Sierra Pacific Veterans Integrated Service Network Director confirms the San Francisco Healthcare System and the Sierra Pacific Veterans Integrated Service Network Clinical Resource Hub leaders complete a review of clinical care rendered by physicians with lapsed privileges as required by the Veterans Health Administration directive.

No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health ensures the Veterans Health Administration National Program Director, Sleep Medicine and the National Sleep Medicine Field Advisory Board review sleep medicine privileges and provide national guidance for sleep medicine physicians who seek other specialty privileges.

No. 5
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The San Francisco Healthcare System Director ensures that the Sierra Pacific Veterans Integrated Service Network Clinical Resource Hub director addresses sleep medicine physicians’ concern of potential for disruptions in sleep medicine services without dual privileges and notifies sites receiving Sierra Pacific Veterans Integrated Service Network Clinical Resource Hub services if sleep medicine privilege changes will disrupt services.