From the U.S. Government Accountability Office, www.gao.gov Transcript for: Monitoring VA's Clinical Productivity and Efficiency Description: The Department of Veterans Affairs has faced challenges managing its budget and ensuring that veterans have access to health care. So, how can the VA accurately measure whether it's providing quality health care? Related GAO Work: GAO-17-480: VA Health Care: Improvements Needed in Data and Monitoring of Clinical Productivity and Efficiency Released: June 2017 [ Background Music ] [ Randy Williamson: ] I would liken it to a field of butterflies, where every butterfly is going different directions. [ Background Music ] [ Sarah Kaczmarek: ] Welcome to GAO's Watchdog Report. Your source for news and information from the U.S. Government Accountability Office. I'm Sarah Kaczmarek. The Department of Veterans Affairs has faced challenges, both in managing its budget, and ensuring that veterans have access to healthcare. A team led by Randy Williamson, a director on our Health Care team, recently took a look at how the VA measures the care it provides at its medical centers. So first I asked Randy, how does the VA know that they are providing good healthcare to veterans? [ Randy Williamson: ] Well, this report really talked about the efficiency and productivity of that. Productivity is basically physician's workload and issues around that. As you could imagine, physicians, on a daily basis, do a number of procedures, some of which are much more complex. An orthopedist, for example, might set a broken finger, and during the day, also, set a broken leg, which requires usually more skill, time, and effort. So, what they do is VA assigns a relative value unit, which just weights the procedure in terms of its time and skill level required, and accumulates that on a biweekly basis, and then for each service, like orthopedics or cardiology, whatever, they feed that information back to the medical center, along with how it stacks up against other medical centers. And if a medical center is at the low end of productivity, then VA headquarters requires them to do a mediation plan. So that's kind of how the productivity works. Efficiency is much more geared to costs and expenditures. It includes a dozen or so different components. For example, look at pharmacies, and expenditures on drugs versus the expected expenditures. Radiology procedures and how they stack up. Unlike the productivity measures, VA headquarters doesn't require them to do anything with it, no remediation plans, and it's just information for the VA MC's to use. [ Sarah Kaczmarek: ] So, do these measures provide a complete and accurate picture of what's going on? [ Randy Williamson: ] Unfortunately not, let me give you some examples. Under productivity, for example, and workload, the measures that VA have only measure the VA employed providers. In many cases, VA medical centers will contract with providers outside of VA to come in and supplement their own providers, and they don't count the workload of contracted providers, which, in many cases, can be substantial. Another thing that they don't count is the work of nurse practitioners, who also provide many services, and that workload is not counted. [ Sarah Kaczmarek: ] So let me bring the focus back to veterans. Why is accurate and complete data important? [ Randy Williamson: ] Well, let me say this. VA is having issues now with providing access to veterans, and they're scrambling in many ways to do that. If certain facilities have low productivity, in other words, their workload is low compared to others, they're doing something, or something's happening that veterans are not being seen at the rate of other facilities. And it's important, from an access issue, especially the wait times could be longer in areas where, and locations where there -- there's low productivity, and so it's really important, from an access issue, and in certain case cost issues too, because a number of veterans will have to go outside VA, and that expense can be a lot more. [ Background Music ] [ Sarah Kaczmarek: ] Alright, so, it sounds like these issues are impacting even just how many veterans have access to healthcare at VA medical centers. I knew Randy would give me some insight on his team's recommendations. [ Randy Williamson: ] I think the real issues center around oversight and accountability. Basically, there, we're talking about, for efficiency reports, for example, there's no requirement now to respond to low-efficiency data, and that needs to be changed. There needs to be some acknowledgement from the VA MC's, the medical centers, what are they going to do about low productivity or low efficiency? The other thing is a much larger issue that has to do with is central office monitoring the remediation plans they are getting, and what are they doing about it? From a management standpoint, the system needs to be managed a whole lot better, information shared among facilities, and so on--that's not going on right now. [ Sarah Kaczmarek: ] And, finally, what do you see as the bottom line of this report? [ Randy Williamson: ] This really focuses on a core problem in VA, and that is accountability and oversight. That's an area that we see over and over again in the reports we do. And the real effect of that is that veterans who need care may be restricted, in terms of access, if productivity and efficiency is lower at certain medical centers. It really can affect -- low productivity can affect the number of veterans that the facilities are capable of seeing, and that is the bottom line. To correct that, VA needs to -- VA central office needs to do this at managing the process as opposed to kind of watching what's going on. I would liken it to a field of butterflies. Where every butterfly is going different directions, and if this process is going to be managed, the butterflies need to be flying in formation. [ Background Music ] [ Narrator: ] Thanks for listening to the Watchdog Report. To hear more podcasts, subscribe to us on iTunes. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.