VA/DOD Health Care:

Further Opportunities To Increase the Sharing of Medical Resources

HRD-88-51: Published: Mar 1, 1988. Publicly Released: Mar 1, 1988.

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In response to a congressional request, GAO reviewed the Veterans Administration's (VA) and the Department of Defense's (DOD) implementation of legislation to promote their sharing of health care resources, to determine: (1) whether the two agencies took full advantage of opportunities to share their resources; (2) the adequacy of current incentives to share resources; (3) whether there were any barriers to their sharing arrangements; and (4) whether administrative or legislative changes could further encourage sharing.

GAO found that: (1) VA and DOD made significant progress in sharing their health care resources; (2) as of September 1986, the agencies had entered into 240 agreements; (3) although the agencies did not estimate cost reductions resulting from the agreements, both VA and DOD data indicated that reductions occurred; (4) local hospitals believe that the sharing agreements provide patients with better access to health care; and (5) VA and the Air Force developed agreements for the joint use of hospitals, which could serve as models for other federal facilities. GAO also found that: (1) the high reimbursement rates at VA medical centers discouraged many military hospitals from sharing their health care services with VA; (2) DOD reimbursement procedures did not provide sharing incentives; (3) the Office of Management and Budget (OMB) rejected a VA proposal to allow DOD dependents to be treated under sharing agreements; and (4) congressional and DOD restrictions on the use of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) funds have limited DOD use of nearby medical centers.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress is not amenable to expanding VA beneficiary population, but the National Defense Authorization Act for Fiscal Year (FY) 1990 provided authority to the military services to use CHAMPUS funds to reimburse VA for services procured under VA/DOD sharing agreements.

    Matter: Congress should enact legislation authorizing VA to accept all categories of DOD beneficiaries under a VA/DOD sharing agreement on a space-available, referral basis when care of VA beneficiaries would not be adversely affected. Specifically, 38 U.S.C. 5011(d)(1) should be amended to remove the restriction on VA providing health care to DOD beneficiaries.

  2. Status: Closed - Implemented

    Comments: The National Defense Authorization Act for FY 1990 incorporated this recommendation.

    Matter: Congress should amend the National Defense Authorization Act for fiscal year 1987 to specifically authorize the military services to use CHAMPUS funds to purchase care from VA medical centers, when it is cost-effective to do so.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD and VA are jointly revising sharing guidelines to implement this recommendation. Revised guidelines were published in May 1989.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should enhance VA and DOD medical sharing opportunities by notifying each of their medical center directors, hospital commanders, and audit and inspection organizations that, under the VA/DOD Health Care Resources Sharing Guidelines, reimbursement rates may be locally negotiated at less than total cost.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD and VA are jointly revising sharing guidelines to implement this recommendation. Revised guidelines were published in May 1989.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should enhance VA and DOD medical sharing opportunities by notifying each of their medical center directors, hospital commanders, and audit and inspection organizations that, under the VA/DOD Health Care Resources Sharing Guidelines, reimbursement rates may be locally negotiated at less than total cost.

    Agency Affected: Veterans Administration

  3. Status: Closed - Implemented

    Comments: DOD planned to issue guidelines to implement this recommendation by October 1, 1988. However, congressional action in the appropriations process delayed this until early 1989. Guidelines issued in May 1989 will implement this recommendation.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense (Comptroller), in consultation with the service secretaries, to develop procedures to ensure that DOD hospital managers are explicitly informed of the amounts of resources being provided to handle anticipated reimbursable work under Public Law 97-174.

    Agency Affected: Department of Defense

 

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