VA Long-Term Care:

More Accurate Measure of Home-Based Primary Care Workload Is Needed

GAO-04-913: Published: Sep 8, 2004. Publicly Released: Sep 8, 2004.

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Randall B. Williamson
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The Department of Veterans Affairs (VA) provides a variety of long-term care services that includes nursing home care and noninstitutional care provided in community-based settings or in the homes of veterans. One important noninstitutional service is home-based primary care, which uses a multidisciplinary team approach involving VA health care providers and others such as social workers to treat veterans who are homebound. As part of GAO's work for the Committee on Veterans' Affairs, House of Representatives, to assess how VA meets veterans' long-term care needs, GAO reviewed how VA measures workload for home-based primary care and five other noninstitutional services.

The amount of home-based primary care veterans receive is not accurately reflected in VA's workload measurement for that service. VA measures home-based primary care workload using the number of days a veteran is enrolled in the program rather than the number of visits the veteran received. For example, if a veteran was enrolled in VA's home-based primary care program for 1 week, and received two visits from VA providers that week, VA would calculate the workload using 7 days, rather than two visits. As a result, using enrolled days as the workload unit of measure overstates the amount of home-based primary care actually received by veterans. In fiscal year 2003, VA reported an average daily workload for home-based primary care of 8,370 using enrolled days; in contrast, GAO determined that using the number of visits results in a workload of 944. In addition, VA's measurement of home-based primary care using enrolled days is inconsistent with the way it measures workload for the other noninstitutional long-term care services GAO reviewed. VA measures workload for these other services using the number of visits a veteran received. As a result, VA's workload total for home-based primary care overstates that service's use compared to other noninstitutional services VA provides.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendation for Executive Action

    Recommendation: Because the number of visits is a more accurate measure of the homebased primary care services veterans receive than enrolled days, the Secretary of Veteran Affairs should direct the Under Secretary for Health to use visits to measure and report the amount of home-based primary care services veterans receive.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Not Implemented

    Comments: While VA continues to review and analyze data on patient census, visits, and number of patients treated for home-based primary care services, it will continue to use patient census for reporting purposes which is based on program enrollment rather than visits. VA is not planning to replace the current measure of patient census for reporting purposes.

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