VA Health Care:

Use of Private Providers Should Be Better Controlled

HRD-92-109: Published: Sep 28, 1992. Publicly Released: Sep 28, 1992.

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Pursuant to a congressional request, GAO examined the Department of Veterans Affairs' (VA) controls for ensuring that it appropriately purchased private outpatient medical care.

GAO found that: (1) in fiscal year 1990, VA spent about $112 million for over 1 million private outpatient visits for 223,000 veterans; (2) some VA jurisdictions routinely authorized private care for veterans without determining whether VA facilities could more economically provide the services; (3) VA staff did not require or consider cost comparisons and based decisions on such other factors as medical condition and distance from residences to VA facilities; (4) VA staff inappropriately authorized veterans to receive private care for treatment of any medical condition, rather than authorizing private treatment plans for existing conditions; (5) VA staff routinely extended long-term authorizations for private medical care without evaluating veterans' continued eligibility for private care; (6) VA staff lacked adequate guidance for conducting cost comparisons; (7) neither VA headquarters nor regional offices monitor medical centers' private-care authorization practices and procedures, relying on VA Inspector General audits as their primary oversight mechanism, and VA did not routinely follow up on those medical centers reported to have deficiencies in private-care authorization procedures; and (8) VA medical centers attempted to improve private-care authorization procedures by reducing the number of long-term authorizations, improving collaborative review of authorizations, and assigning personnel to assist in evaluating needs for private care.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In January 1995 VA issued guidelines that stated VA has authority to contract for private care only when: (1) medical services are not available at VA; or (2) VA is incapable of economically providing the required medical services due to geographic inaccessibility.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to clarify to medical centers that private care should only be purchased from private providers when the needed services are not available at VA facilities or the private providers can treat veterans considered geographically inaccessible more economically than VA facilities can treat them.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: The January 1995 guidelines require that a cost comparison be made when VA can provide the needed medical care or services, but VA is not capable of furnishing economical care or services due to geographical inaccessibility. The guidelines provide instructions on how such cost comparisons should be developed.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to provide medical centers with procedures, including implementing guidance, on how to develop cost comparisons for use in authorizing private care.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: The January 1995 guidelines require that the appropriateness of non-VA medical care authorizations for all veterans must be reevaluated. The guidelines spell out the types of analysis and documentation required for evaluations and reviews of appropriateness of private care. The evaluations and reviews must be completed before such care is authorized.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to ensure that all medical centers reevaluate the appropriateness of private care authorizations for all veterans currently authorized private care.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Not Implemented

    Comments: VA developed a Fee-Basis Status Report, which provides information regarding the overall operation of facilities' fee-basis programs. But additional staffing is needed, according to VA, to review individual facilities' reports and to incorporate the review into site visits.

    Recommendation: The Secretary of Veterans Affairs should require the Chief Medical Director to develop and implement a process for monitoring centers' compliance with VA policies and procedures for use of private providers to treat veterans.

    Agency Affected: Department of Veterans Affairs

 

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