Veterans Affairs Health Care Added to GAO High Risk List

Posted by IntegrityM | | Government Evaluation

In 2015, the Veterans Affairs (VA) Health Care achieved a distinction held by two other large Federal health care programs – Medicare and Medicaid – that of being designated a Government Accountability Office (GAO) high risk program. VA Health Care was added to the GAO High Risk List in response to its problems providing adequate access to care and maintaining high-quality, safe, and cost-effective care across its facilities.

2015 GAO Report Findings

VA operates one of the largest health care systems in the United States. The system includes approximately 150 medical centers and more than 800 outpatient clinics. In 2002, VA health care served 6.8 million veterans. By 2013, the number had increased to 8.9 million. To account for this growth in veterans served (many of whom have complex medical needs as they return from war) and the increasing cost of health care, Congress increased the VA health care budget from $23 billion to $55.5 billion – an increase of more than $32 billion – during this same period.

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The 2015 GAO report gives five reasons for designating VA health care as high risk:

  • Ambiguous policies and inconsistent processes. GAO found ambiguous VA policies led to inconsistencies in the way VA facilities carried out processes at the local level. These inconsistencies posed risks to veterans’ access to VA health care and to the quality and safety of the care provided.
  • Inadequate oversight and accountability. GAO found VA did not routinely assess policy implementation across VA facilities, VA’s oversight activities were not always sufficiently focused on its facilities’ compliance with applicable requirements, and VA’s oversight efforts were often impeded by its reliance on facilities’ self-reported data, which lacked independent validation and were often inaccurate and incomplete.
  • Information technology challenges. GAO noted concern with the outdated, inefficient nature of certain systems, along with a lack of system interoperability.
  • Inadequate training for VA staff. GAO identified gaps in VA training, leading to potential quality and safety risks for veterans’ health, as well as training requirements that were particularly burdensome to complete.
  • Unclear resource needs and allocation priorities. GAO found gaps in the availability of data VA required to efficiently identify resource needs and to ensure resources were effectively allocated across the VA health care system.

The GAO report notes VA has made progress in addressing recommendations related to VA health care however, it points out VA health care has more than 100 recommendations not yet fully resolved. The GAO’s concerns about VA’s management and oversight of its health care system, and thus the timeliness, cost-effectiveness, quality, and safety of veteran’s health care is the reason it was included in the GAO High Risk List in 2015.

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Integrity Management Services (IntegrityM) can help organizations facing system-wide challenges. We are experts in designing and conducting government program and project evaluations. Several of our senior staff led and managed evaluations in Federal Offices of Inspector General. We use a mix of qualitative and quantitative methods, and conduct both short turnaround and longitudinal, as well as formative and summative evaluations. We follow the Quality Standards for Inspection and Evaluation (Blue Book) issued by the Council of the Inspectors General on Integrity and Efficiency.

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To complement our evaluation and compliance offerings, we have on staff Ph.D. and Masters level statisticians, experienced data analysts, and trained medical reviewers. Although GAO and other oversight offices can and do identify problems and offer recommendations, IntegrityM can work with your organization to dig deeper and create lasting solutions. Learn more about our government program evaluation services here.


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