Disabled Veterans' Care:

Better Data and More Accountability Needed to Adequately Assess Care

HEHS-00-57: Published: Apr 21, 2000. Publicly Released: May 16, 2000.

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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) compliance with the requirements to maintain capacity and access for veterans with special disabilities, focusing on: (1) the accuracy of the conclusions in VA's fiscal year (FY) 1998 annual capacity report; and (2) challenges facing VA in managing its special disability programs.

GAO noted that: (1) VA concluded in its annual report for FY 1998 that it had maintained its capacity to treat veterans with special disabilities; (2) however, VA's data are not sufficient to support that conclusion because of extensive data problems, such as the use of unreliable proxy measures to identify veterans with special disabilities; (3) moreover, VA based its conclusion on national statistics that indicated more special disability veterans were served with fewer resources expended in 1998 than in 1996; (4) however, there is considerable variability among the Veterans Integrated Service Networks (VISN), and, in fact, some VISNs reported serving fewer veterans; (5) in addition, VA attributes reduced expenditures and the use of fewer resources to efficiency gains--however, because it lacks outcome measures, VA cannot tell whether it has maintained, enhanced, or diminished quality of care; (6) VA faces challenges in maintaining its capacity to serve special disability populations; and (7) in particular, the lack of a single VA headquarters unit accountable for ensuring compliance with the capacity legislation may have caused delays in: (a) monitoring and investigating locations where capacity appears to have declined; and (b) fully implementing congressionally mandated performance standards for VA employees responsible for allocating and managing special disability program resources.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA created a position in the Office of Patient Care Services to serve as the national coordinator for special disability program activities. The person will work with field and headquarters' offices responsible for service delivery, data, quality, resource and reporting issues, and will serve to provide increased emphasis on VA's continuing efforts to better coordinate responsibilities among the various offices. In addition, each Veterans Integrated Service Network (VISN) designated their clinical manager as coordinator for special disability programs to work with the headquarters' coordinator.

    Recommendation: To help ensure compliance with the law, the Secretary of Veterans Affairs should direct the Under Secretary for Health to assign lead responsibility to a headquarters unit for initiating efforts to monitor and determine the causes for apparent declines in capacity.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA has appointed a national coordinator for special disability program activities located in the Office of Patient Care Services. This coordinator has been assigned the task of ensuring that the job performance standards for employees who are responsible for allocating and managing the resources used to serve veterans with special disabilities are completed and implemented. Performance standards, related to the quality of care provided to special disability program patients have been implemented for VA's 22 network directors. In addition, performance standards related to the maintenance of capacity to treat all types of special disability program patients have also been implemented.

    Recommendation: To help ensure compliance with the law, the Secretary of Veterans Affairs should direct the Under Secretary for Health to assign lead responsibility to a headquarters unit for developing job performance standards for employees who are responsible for allocating and managing the resources used to serve veterans with special disabilities.

    Agency Affected: Department of Veterans Affairs

 

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