Veterans:

Providing Veterans With Service-Connected Dental Problems Higher Priority at VA Clinics Could Reduce Fee-Program Costs

HRD-81-82: Published: Jun 19, 1981. Publicly Released: Jul 20, 1981.

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GAO was requested to review selected aspects of the Veterans Administration's (VA) dental program.

The review showed that fewer veterans with service-connected dental conditions would be referred to private dentists and, as a result, substantial savings would be achieved if VA: (1) established priorities for providing dental care in accordance with the Veterans Health Care Amendments of 1979; (2) insured that care was provided only to veterans eligible for care; and (3) made better use of its dental personnel. The fee-basis was intended to be used only if a veteran was unable to obtain care from a VA facility because of geographical inaccessibility or because of the inability of the VA facility to provide the type of care required. However, VA uses the fee program primarily as a means of expanding its ability to provide routine dental services to inpatients with nonservice-connected dental conditions. By reducing the number of ineligible veterans provided dental services, VA clinics could increase their capacity to treat outpatients with service-connected dental conditions and further reduce fee-basis referrals. In a 1973 report, GAO stated that VA could reduce the number of fee-program referrals by increasing the productivity of VA dental clinics.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should establish workload indicators for dental personnel.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should direct the Medical Administrative Service at each VA medical center to determine whether a veteran has a service-connected dental condition at the time of admission.

    Agency Affected: Veterans Administration

  3. Status: Closed - Not Implemented

    Comments: A followup will be provided in a report concerning VA staffing guidelines.

    Recommendation: The Administrator of Veterans Affairs should implement the recommendations in the March 1980 GAO report that VA expand the use of expanded function dental auxiliaries.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should adapt the American Dental Association and Department of Defense dental procedures reporting systems for use by VA dental clinics.

    Agency Affected: Veterans Administration

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should establish a uniform 40-mile definition of geographical inaccessibility and require specific justification from VA clinics for any deviation from the rule.

    Agency Affected: Veterans Administration

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should direct VA dental clinics to place a higher priority on the provision of dental care to outpatients with service-connected dental conditions than on the provision of routine dental care to inpatients with no service-connected dental condition.

    Agency Affected: Veterans Administration

  7. Status: Closed - Not Implemented

    Comments: VA has cut back on the scope of examinations which meets the intent of the recommendation.

    Recommendation: The Administrator of Veterans Affairs should direct VA clinics to provide dental examinations to inpatients not service connected for dental conditions only if the clinic's staff and facilities are not needed for the provision of care to veterans service connected for dental conditions unless (1) the admitting and/or attending physician determines that there are compelling medical reasons for giving the veteran an examination; or (2) the veteran has a dental emergency.

    Agency Affected: Veterans Administration

  8. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should enforce established procedures for authorizing fee-basis care, including requirements that: (1) fee-basis care be authorized only if the clinic cannot schedule treatment within 60 days, considering the total clinic resources; (2) the availability of care at VA facilities near the veteran's home be determined before fee-basis care is authorized; and (3) fee-basis care not be a prerogative of the veteran.

    Agency Affected: Veterans Administration

  9. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should strengthen procedures for authorizing outpatient dental care for nonservice-connected dental conditions to insure that such care is authorized only if treatment was begun while the veteran was an inpatient and if completion of the treatment is necessary in relation to a medical problem for which it was prescribed.

    Agency Affected: Veterans Administration

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should take steps to improve the reliability of data reported under the automated medical information system program.

    Agency Affected: Veterans Administration

  11. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should implement recommendations made in the 1973 GAO report to: (1) expand the use of two-chair dentistry; (2) expand the use of dental hygienists and assistants; (3) expand the use of trained medical administrative personnel to perform fee program administrative duties; and (4) reduce the number of broken appointments.

    Agency Affected: Veterans Administration

 

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