VA Abuses Physician Incentives

Note: The C-123 Veterans note that performance expectations of military personnel, up to the point of sacrifice of life and limb, are expected and not rewarded with any bonus.

The Department of Veterans Affairs awards performance-pay bonuses to doctors without a clear policy on merits for the payments that average $8,000 a year and that go, in some cases, to physicians disciplined or reprimanded, says a governmental review.

According to a Government Accountability Office report recently issued, investigators found that during the 2010 and 2011 fiscal years:

• A $7,663 performance-pay bonus went to a VA doctor who was reprimanded for practicing medicine with an expired license for three months.

• A $11,189 bonus was given to a surgeon who was suspended without pay for 14 days after leaving an operating room before surgery was completed, allowing residents to continue unsupervised.

• A $7,500 pay bonus went to a doctor who was reprimanded for refusing to see assigned patients in an emergency room, actions that forced 15 patients to wait six hours to be treated and led nine other patients to leave without treatment.

• An $8,216 bonus was paid to a radiologist whose privileges had been reduced for failing to read mammograms and other complex images competently.

The VA medical centers' records show that doctors could receive performance pay without taking disciplinary actions into consideration. According to the GAO report, this was evidence that there is no consistent policy for paying out the money, and no clear direction from VA headquarters.

"What we found is that the (performance pay) policy is not clear," said Debra Draper, the lead investigator. "Oversight is inadequate."

The VA issued a statement Thursday promising to fix the process by Oct. 31 and "ensure that policies are revised to clearly articulate the overarching goal of high-quality care for veterans and the need for proper oversight and documentation of pay awards."

The VA spent $150 million on performance-pay awards to doctors and dentists in 2011. When the performance payments were created in 2004, the money was meant to recognize doctors who achieve quality, productivity and support overall goals for the VA. But the VA allowed individual medical centers to decide how to give out the money.

"This is irrefutable proof of what we've known for quite some time: that in many cases, VA's performance pay and bonus system has absolutely nothing to do with performance," says Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.

The performance pay is not required to be given, but the GAO found that likely more than 80% of eligible VA doctors or dentists get it.

Victoria Dillon, a VA spokesperson, said performance payments help to "recruit and retain highly skilled medical professionals." But she said steps have been taken to "increase monitoring requirements so that pay and awards are supported by proper documentation of performance and meet established standards."

The GAO performance audit was conducted for more than a year through July and focused on four VA facilities in Texas, Washington, Maine and Georgia.