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    Subject Term: "Health care personnel"

    23 publications with a total of 57 open recommendations including 6 priority recommendations
    Director: Debra A. Draper
    Phone: (202) 512-7114

    5 open recommendations
    Recommendation: The Undersecretary for Health should develop and implement a process to accurately count all physicians providing care at each medical center, including physicians who are not employed by VHA. (Recommendation 1)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should develop and issue guidance to the VAMCs on determining appropriate staffing levels for all mission-critical physician occupations. (Recommendation 2)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should ensure that when multiple offices issue similar productivity data on physician occupations, any methodological differences are clearly communicated and guidance is provided on how to interpret and reconcile the data. (Recommendation 3)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should establish a system-wide method to share information about physician trainees to help fill vacancies across VAMCs. (Recommendation 4)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should conduct a comprehensive, system-wide evaluation of the physician recruitment and retention strategies used by VAMCs to determine their overall effectiveness, identify and implement improvements, ensure coordination across VHA offices, and establish an ongoing monitoring process. (Recommendation 5)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Katherine M. Iritani
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Secretary of HHS should expeditiously develop a plan--that includes priorities, timeframes, clear roles and responsibilities, and methods for assessing progress--to effectively implement the NAS-related recommendations identified in the Protecting Our Infants Act: Final Strategy. (Recommendation 1)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    3 open recommendations
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Director, USMEPCOM, and the military services develop a clear process with defined roles and responsibilities to ensure that complete Existed Prior to Service (EPTS) separation medical records for enlistees who separated within 180 days of service from the military services' basic training sites are provided to USMEPCOM.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Director, USMEPCOM, establish a schedule to repair the internal EPTS database so that USMEPCOM can provide more regular and specific feedback to MEPS chief medical officers.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Under Secretary of Defense for Acquisition, Technology, and Logistics and the DOD Healthcare Management Systems Program Executive Office, develop a schedule of actions for deploying its new electronic health record system, MHS GENESIS, within USMEPCOM that includes key activities such as the major actions required to accomplish this effort, completion dates for all actions leading up to these events, and dates for the system's deployment to MEPS locations.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Elizabeth H. Curda
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To help ensure that HHS agencies and offices fully understand the requirements and processes for the temporary reassignment authority, their responsibilities under the authority, and that ASPR is adequately and comprehensively assessing the effect of the authority on public health emergency response and medical surge, the Secretary of HHS should direct ASPR to conduct outreach to HHS agencies and offices that administer programs eligible for the reassignment authority to inform them of their responsibilities and ASPR's expected time frames for reviewing and approving states' and tribes' requests for personnel reassignments, and inform them of their responsibilities and ASPR's expectations for reviewing states' and tribes' after-action reports.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure that HHS agencies and offices fully understand the requirements and processes for the temporary reassignment authority, their responsibilities under the authority, and that ASPR is adequately and comprehensively assessing the effect of the authority on public health emergency response and medical surge, the Secretary of HHS should direct ASPR to develop a plan to evaluate states' and tribes' after-action reports to assess the impact of the reassignment authority on states' public health emergency response and medical surge and to provide technical assistance as necessary.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Farrell, Brenda S
    Phone: (202) 512-3604

    6 open recommendations
    Recommendation: To fully assess the size and composition of the medical force, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to conduct a new analysis of the required number of active-duty and civilian medical personnel that mitigates known limitations.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To strengthen ongoing efforts to analyze the costs of medical force readiness and establish clinical currency standards, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to take steps to identify and mitigate limitations regarding the standard for maintaining providers' clinical skills, including improving the accuracy of information concerning providers' workload and conducting an analytically rigorous calculation of active-duty providers' time devoted to military-specific responsibilities.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help achieve DOD's goals for transferring health care into its own facilities and increasing the productivity of active-duty medical providers, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to develop a strategy for achieving these goals that reflects the leading practices of effective federal strategic planning.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To strengthen ongoing efforts within DOD to address the Study's recommendations to use the provider model outputs to inform execution of health care delivery and to refine the model for future use, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to modify DOD's model to reflect the military service of the physicians and military treatment facilities included in the model.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To strengthen any future assessments of additional changes to DOD's network of military treatment facilities, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to describe steps taken to assess the reliability of data supporting the assessment, including, at a minimum, the sources of data, data limitations, and efforts to test data reliability.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To strengthen any future assessments of additional changes to DOD's network of military treatment facilities, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to include in any accompanying cost estimates an appropriate level of detail, all significant costs, and an assessment of the reliability of the data supporting the cost estimate.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Elizabeth Curda
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: In order to ensure that veterans receive quality care from qualified physicians, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop and implement a comprehensive oversight strategy that includes ongoing monitoring and evaluations of the contractors' verification of PC3 and Choice physicians' credentials, as well as VHA staff's review of Choice physicians. VHA's oversight should include reviewing documentation and assessing whether the contractors' plans for improving their processes for Choice credentials verification are effective.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: In June and July 2017, the Veterans Health Administration (VHA) completed separate audit evaluations of both contractors' verification of Patient-Centered Community Care (PC3) and Choice physicians' credentials. This supplements the ongoing monitoring that VHA already had in place for routinely and independently checking the credentials for a sample of PC3 and Choice providers. However, as of October 2017, VHA has not yet implemented a strategy to oversee VHA staff's review of Choice physicians through the VHA Choice Provider Agreement program.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    7 open recommendations
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to assess the Triad of Care model's effectiveness in light of the changes in WTU diagnoses and take the appropriate action.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to exercise oversight responsibility to track full adherence to selection processes for squad leaders and platoon sergeants, including the requirement to conduct interviews for these positions.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to develop a mechanism to conduct post-training assessments on squad leaders and platoon sergeants' application of training to the work environment and incorporate the results into the training program.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to develop plans to adjust staff levels, if needed, to accommodate a potential future surge in demand.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to establish a process that assigns oversight responsibility for tracking instances in which Commanders make exceptions to WTU entrance criteria so that the Army Surgeon General is aware of the extent Commanders' decisions are consistent with program goals.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to develop and implement an approach and associated procedures for providing senior leadership, such as the Warrior Transition Command, with complaints information concerning the WTU program and WTU soldiers.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure the best use of resources for managing the medical care of soldiers recovering from serious medical conditions, the Secretary of the Army should direct the Chief of the Army Reserve, in conjunction with the Army Surgeon General, to develop an analysis that compares the costs and benefits of maintaining the current system of Community Care Units with the costs and benefits of expanding the Reserve Component Managed Care program.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Kathleen King
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure that timely primary care is available and accessible to AI/AN people, the Secretary of HHS should direct the Director of IHS to monitor patient wait times in its federally operated facilities and ensure corrective actions are taken when standards are not met.

    Agency: Department of Health and Human Services
    Status: Open
    Priority recommendation

    Comments: As of June 2017, according to IHS, the implementation of an agency-wide standard for patient wait times will be accomplished as follows: A decision will be made on the standard to be used, by the IHS Director no later than July 2017. Using a pilot sample of facilities (two to four facilities), the standard will be assigned to the Area Directors over the selected pilot facilities in October 2017. Systems of measurement will be decided and communicated to the Area Directors for the pilot facilities. By December 31, 2017, three months of activity will be analyzed and evaluated against the standard. Between January and March, 2018, adjustments to the necessary systems of measure, or adjustments to the reasonably expected performance standard will be made. A final evaluation will be performed not later than September 2018, and final adjustments will be made to either the measurement system or the standard to allow for full implementation of the standard across all IHS Areas by October, 2018.
    Director: Andrew Sherrill
    Phone: (202) 512-7215

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help determine whether current efforts are effective or if additional action may be needed, such as development of a workplace violence prevention standard for health care employers, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to develop and implement cost-effective ways to assess the results of the agency's efforts to address workplace violence.

    Agency: Department of Labor
    Status: Open
    Priority recommendation

    Comments: According to OSHA officials, the agency has a study underway that will review OSHA's workplace violence enforcement cases in health care to better understand the obstacles OSHA compliance officers encountered during these investigations and identify factors which led to citations. OSHA expects the final report to be completed in 2017, which will help its compliance officers develop citations in workplace violence cases. In addition, in December 2016, OSHA published a Request for Information on Preventing Workplace Violence in Healthcare and Social Assistance (RFI), which will help the agency identify workplace violence prevention requirements that could be effective and economical if a regulation were to be developed. The comment period closed in April 2017. In June 2017, the agency reported that it is reviewing the information received through the RFI. As of August 2017, the Prevention of Workplace Violence in Health Care and Social Assistance rulemaking status is classified as a long term regulatory action. To fully implement this recommendation, DOL should complete its ongoing study to better understand the obstacles OSHA compliance officers encountered during these investigations and identify factors that led to citations; and analyze the input received from the RFI to determine whether regulatory action is needed.
    Director: Rebecca Gambler
    Phone: (202) 512-8777

    1 open recommendations
    Recommendation: To enhance Department of Homeland Security's (DHS) U.S. Immigration and Customs Enforcement's (ICE) ability to make more effective business decisions across immigration detention facilities with respect to the provision of medical care, the Secretary of Homeland Security should direct ICE to track inspection results and conduct analyses of oversight data over time, by standards, and by facility type.

    Agency: Department of Homeland Security
    Status: Open

    Comments: As of May 2017, ICE has not provided a status update regarding the implementation of this recommendation. We will provide updated information after confirming any agency actions.
    Director: James Cosgrove
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: In order to prevent the shift of services from physician offices to HOPDs from increasing costs for the Medicare program and beneficiaries, Congress should consider directing the Secretary of HHS to equalize payment rates between settings for E/M office visits--and other services that the Secretary deems appropriate--and to return the associated savings to the Medicare program.

    Agency: Congress
    Status: Open

    Comments: When we determine what steps the Congress has taken, we will provide updated information.
    Director: Kathleen M. King
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To ensure that HHS workforce efforts meet national needs, the Secretary of Health and Human Services should develop a comprehensive and coordinated planning approach to guide HHS's health care workforce development programs--including education, training, and payment programs--that (1) includes performance measures to more clearly determine the extent to which these programs are meeting the department's strategic goal of strengthening health care; (2) identifies and communicates to stakeholders any gaps between existing programs and future health care workforce needs identified in the Health Resources and Services Administration's workforce projection reports; (3) identifies actions needed to address identified gaps; and (4) identifies and communicates to Congress the legislative authority, if any, the Department needs to implement the identified actions.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In December 2016, HHS indicated that the agency had not yet taken steps to implement a comprehensive workforce planning effort. Officials said that for the FY2018 cycle, HHS had planned to expand its group developing legislative proposals to include budget issues and gaps that warrant attention. While it did not do so during that cycle, officials indicated that they would recommend this broader approach to workforce planning for future budget and legislative cycles.
    Director: Debra Draper
    Phone: (202) 512-7114

    3 open recommendations
    including 2 priority recommendations
    Recommendation: To help ensure the effective recruitment and retention of nurses across VA medical centers, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a periodic reporting process to help monitor VA medical center compliance with the policies and procedures for each of its key recruitment and retention initiatives.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VHA convened a taskforce with accompanying charter to address all three of GAO's recommendations, including medical center compliance with policies and procedures for the key recruitment and retention initiatives. The taskforce consists of workgroups that are charged with reviewing current processes for reporting on compliance for the eight recruitment and retention initiatives we identified in our report, identifying opportunities for improvement, and developing recommendations to optimize medical centers' reporting on compliance. Based on the workgroup recommendations, VHA will generate and implement program-specific approaches for reporting on compliance of the initiatives. As of March 2017, the workgroups have reviewed, or are in the process of reviewing, compliance reporting processes for all eight initiatives. VHA anticipates implementing compliance reporting processes by October 2017.
    Recommendation: To help ensure the effective recruitment and retention of nurses across VA medical centers, the Secretary of Veterans Affairs should direct the Under Secretary for Health to evaluate the adequacy of training resources provided to all nurse recruiters at VA medical centers to ensure that they have the tools and information to perform their duties efficiently and effectively.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VHA convened a taskforce with accompanying charter to address all three recommendations, including evaluating training resources provided to nurse recruiters. VHA stated that it held nurse recruiter training in April 2016 to address immediate training needs and incorporated survey results and recommendations from the field on the training at an August 2016 curriculum redesign meeting. VHA's next national nurse recruiter training sessions are to be held in April and November 2017, as well as four additional intermittent training sessions. In October 2016, VHA stated that it had established a national nurse recruitment division that will focus on national oversight, guidance, training, monitoring of nursing workforce and recruitment matters but did not provide an anticipated date for when it would be able to staff and stand up the new division. VHA noted that it will pursue an external study examining the effectiveness of the role of the nurse recruiter in VHA and a comparison of the effectiveness of nurse recruiters assigned to nurses offices versus those assigned to human resources offices. However, VHA did not provide any information on when it plans to pursue or complete such an evaluation. VHA also noted that the taskforce is exploring improved data collection tools and methods to routinely evaluate the adequacy and effectiveness of training resources provided to nurse recruiters at VA medical centers.
    Recommendation: To help ensure the effective recruitment and retention of nurses across VA medical centers, the Secretary of Veterans Affairs should direct the Under Secretary for Health to conduct a system-wide evaluation of VHA's key nurse recruitment and retention initiatives, to determine the overall effectiveness of these initiatives, including any needed improvements, and communicate results and information in a timely manner to relevant stakeholders.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VHA convened a taskforce with accompanying charter to address all three of GAO's recommendations, including conducting a system-wide evaluation of VHA's key nurse recruitment and retention initiatives and identifying areas for improvement. The taskforce consists of workgroups that are charged with reviewing current processes for reporting on compliance for the eight recruitment and retention initiatives we identified in our report, identifying opportunities for improvement, and developing recommendations to optimize medical centers' reporting on compliance. Based on the workgroup recommendations, VHA will generate and implement program-specific approaches for reporting on compliance of the initiatives. As of March 2017, taskforce has evaluated, or is in the process of evaluating, the effectiveness of each of the eight initiatives. VHA anticipates completing these evaluations by October 2017. However, VHA did not provide any information on its efforts to evaluate the overall effectiveness of the key initiatives in meeting VHA's system-wide nurse recruitment and retention goals.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: To ensure DHA can accurately and consistently assess mental health provider staffing needs across each of the military services, the Secretary of Defense should direct the Secretaries of the Army, Air Force, and Navy to require the medical commands of each military service to include its estimated mental health provider staffing needs generated through PHRAMS in the requirements fields of DHA's quarterly mental health staffing reports.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to ensure DHA, through the PHRAMS contractor, continue to refine PHRAMS to incorporate the needs of the military services to reduce the need for additional service-specific methods of determining mental health provider staffing needs.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To ensure the Defense Health Agency (DHA) can accurately and consistently assess mental health provider staffing needs across each of the military services, the Secretary of Defense should direct the Secretaries of the Army, Air Force, and Navy to require the medical commands of each military service to report any additional service-specific methods they use to determine their final estimates of mental health provider staffing needs.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to require the National Capital Region Medical Directorate to include its estimated mental health provider staffing needs generated through PHRAMS in the requirements fields of DHA's quarterly mental health staffing reports.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to address potential disincentives for staff to detect and prevent physician-assisted fraud, SSA should review the standards used to assess DDS performance; and develop and distribute promising practices to incentivize staff to better balance the goal of processing claims promptly with the equally important goal of identifying and reporting evidence of potential fraud.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA partially agreed with this recommendation, citing that their employees take their stewardship responsibilities seriously and that field office and disability determination services (DDS) employees are the agency's first and best line of defense against fraud. In 2016, the agency reported that it was working with experts in its OIG and Office of Anti-Fraud Programs to develop and disseminate promising practices on identifying and reporting fraud. We will close this recommendation once SSA takes steps to review its standards for assessing DDS performance and disseminates the best practices it is developing.
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to address the potential risks associated with medical evidence submitted by sanctioned physicians, SSA should evaluate the threat posed by this information and, if warranted, consider changes to its policies and procedures.

    Agency: Social Security Administration
    Status: Open

    Comments: As of 2016, SSA reported that it was pursuing several options to address the potential risks of medical evidence submitted by sanctioned physicians. This included determining how it could use licensure information from the List of Excluded Individuals and Entities. SSA stated that it believes the best opportunity to further evaluate the possible review of the license statuses of medical evidence providers is in conjunction with the implementation of the National Vendor File, part of the national Disability Case Processing System, which is under development. In addition, SSA reported it had drafted two Social Security Rulings to define fraud and to provide processes for disregarding evidence and making redeterminations in disability claims when there is reason to believe that fraudulent evidence was provided. We will close this recommendation once SSA articulates a strategy for using license status information in the vendor file and it finalizes its rulings.
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to help ensure new initiatives that use analytics to identify potential fraud schemes are successful, SSA should develop an implementation plan that identifies both short- and long-term actions, including: (1) timeframes for implementation; (2) resources and staffing needs; (3) data requirements, e.g., the collection of unique medical provider information; (4) how technology improvement will be integrated into existing technology improvements such as the Disability Case Processing System and National Vendor File; and (5) how different initiatives will interact and support each other.

    Agency: Social Security Administration
    Status: Open
    Priority recommendation

    Comments: Since fiscal year 2015, SSA has taken several steps that will help the agency to combat fraud, waste, and abuse. SSA established the Office of Anti-Fraud Programs to provide centralized oversight and accountability for the agency's initiatives, which, in consultation with the Office of the Inspector General and other SSA components, will lead the development of SSA's anti-fraud initiatives and activities. This includes efforts to mitigate fraud through data analytics that utilize SSA's existing data systems. SSA developed a strategic plan for fiscal years 2016-2018 to guide its anti-fraud efforts that includes the use of data analytics. However, this plan does not specifically address actions to combat potential physician-assisted fraud. As of April 2017, SSA stated that it continued to develop a fraud management strategy that is consistent with the leading practices identified in GAO's report. Once the strategy is complete, SSA plans to conduct a fraud risk assessment on its major lines of business, beginning with the disability program in fiscal year 2017. We will continue to monitor SSA's progress to identify and prevent fraud schemes that include physicians.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To help ensure adequate and qualified nurse staffing at VAMCs, the Secretary of Veterans Affairs should direct the Interim Under Secretary for Health to enhance VHA's internal controls by completing evaluations of Phase I and Phase II and make any necessary changes to policies and procedures before national implementation of Phase II in all VAMCs.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed with this recommendation and, according to an update received April 2017, VA is taking actions towards addressing this recommendation and expects to complete those actions Fall 2017. When additional information is received GAO will update the recommendation as appropriate.
    Director: Farrell, Brenda S
    Phone: (202)512-3000

    1 open recommendations
    Recommendation: To help ensure that DOD and Congress have visibility over the necessity of the Selective Service System to meeting DOD's needs, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to establish a process of periodically reevaluating DOD's requirements for the Selective Service System in light of changing threats, operating environments, and strategic guidance.

    Agency: Department of Defense
    Status: Open

    Comments: Section 551 of the Fiscal Year 2017 National Defense Authorization Act established the National Commission on Military, National, and Public Service to conduct a review of the military selective service process and consider methods to increase participation in military, national, and public service in order to address national security and other public service needs of the Nation. Section 552 of the Act contained a mandate requiring DOD to submit to the Committees on Armed Services of the Senate and the House of Representatives and to the Commission a report on the current and future need for a centralized registration system under the Military Selective Service Act. This report was submitted by DOD on July 19, 2017. The Commission is required to, not later than 30 months after the Commission establishment date, transmit to the President and Congress a report containing the findings and conclusions of the Commission. The Commission will terminate not later than 36 months after the Commission establishment date. As such, we are leaving this recommendation open until the Commission completes its work and we see if DOD plans to move forward with establishing a process to periodically reevaluate DOD's requirements for the Selective Service System.
    Director: Williamson, Randall B
    Phone: (202)512-3000

    8 open recommendations
    Recommendation: To help ensure that the military services' requirements for physician credentialing and privileging are consistent across the MHS, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Surgeons General of the military services to establish a DOD-wide process to identify and address existing inconsistencies between DOD's and the military services' physician credentialing and privileging requirements, including those inconsistencies we identified in this report.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To help ensure that the military services' requirements for physician credentialing and privileging are consistent across the MHS, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Surgeons General of the military services to establish a DOD-wide process to coordinate all current and future efforts to revise physician credentialing and privileging requirements.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To assure that information on a physician's clinical competence and practice history is documented and available to support credentialing and privileging decisions by Army MTFs, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Army Surgeon General to coordinate individual MTFs' efforts to establish mechanisms to collect and analyze data to evaluate physician performance and support performance assessments.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To assure that information on a physician's clinical competence and practice history is documented and available to support credentialing and privileging decisions by Army MTFs, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Army Surgeon General to clarify requirements for how MTFs document follow-up on peer recommendations, including who is responsible for documenting follow-up and where that documentation should be filed.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To assure that information on a physician's clinical competence and practice history is documented and available to support credentialing and privileging decisions by Army MTFs, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Army Surgeon General to clarify requirements for the information that physicians need to provide in their curriculum vitae (CV) so that MTFs can identify unaccounted for periods in practice history, as well as how MTFs should document explanations of any unaccounted for periods.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To assure that information on a physician's clinical competence and practice history is documented and available to support credentialing and privileging decisions by Army MTFs, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Army Surgeon General to establish requirements for MTFs to document significant events that occur during the review of a credentials file, including which types of significant events should be documented, who is responsible for documenting significant events, and where that documentation should be filed.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To assure that information on a physician's clinical competence and practice history is documented and available to support credentialing and privileging decisions by Army MTFs, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Army Surgeon General to establish a process to ensure that relevant information from the DPDB is documented in the credentials file.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To assure that MTFs are fully complying with DOD's and the military services' requirements for physician credentialing and privileging and implementing these requirements appropriately, the Secretary of Defense should direct the Surgeons General of the military services to establish and implement an oversight process to conduct reviews of a sample of credentials files to identify and address areas of noncompliance and incomplete documentation.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Kohn, Linda T
    Phone: (202)512-3000

    2 open recommendations
    Recommendation: As HHS implements its current and forthcoming efforts to make transparent price information available to consumers, HHS should determine the feasibility of making estimates of complete costs of health care services available to consumers through any of these efforts.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In May 2013, CMS released average inpatient hospital charge information for more than 3,000 hospitals that receive Medicare Inpatient Prospective Payment System payments for the 100 most frequently billed discharges using DRGs from FY2011 and corresponding average Medicare payments. Shortly thereafter CMS also released outpatient charges. In April 2014, CMS also released data on payments to physicians under Medicare part B. This represents an effort to provide price transparency, although these are not complete cost estimates according to our definition in this report. As of September 2015, we are awaiting an update from HHS on the status of this recommendation. We will update the status of this recommendation when we receive additional information.
    Recommendation: As HHS implements its current and forthcoming efforts to make transparent price information available to consumers, HHS should determine, as appropriate, the next steps for making estimates of complete costs of health care services available to consumers.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of September 2015, we are awaiting an update from HHS on the status of this recommendation. We will update the status of this recommendation when we receive additional information.
    Director: Farrell, Brenda S
    Phone: (202)512-3604

    1 open recommendations
    Recommendation: To better understand the extent to which deployed DOD civilian employees have access to needed medical care, as appropriate, the Secretary of Defense should direct the Combatant Commander of U.S. Central Command to clarify the level of care that deployed DOD civilian employees can expect in theater, including their eligibility for routine care.

    Agency: Department of Defense
    Status: Open

    Comments: As of September 2016, DOD has not taken all the steps to close this recommendation. A DOD official stated that, as a result of changes in theater, there have been changes in guidance regarding medical care and they believe the guidance is clear, but they have not received guidance from the Secretary of Defense directing them to clarify the level of care that deployed civilian employees can expect in theater, including their eligibility for routine care.
    Director: Farrell, Brenda S
    Phone: (202)512-3604

    2 open recommendations
    Recommendation: Consistent with DOD emphasis on developing human capital solutions across the services to enable departmentwide decision making and analyses within its Military Health System, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Service Secretaries to identify the common medical capabilities that are shared across the services in their military treatment facilities that would benefit from the development of cross-service medical manpower standards.

    Agency: Department of Defense
    Status: Open

    Comments: Sept 2014 Update: Since the issuance of our report in 2010, DOD officials established a Defense Health Agency as of October 1, 2013, with the goal to take advantage of opportunities to adopt common business and clinical practices. Related to this effort, a joint collaborative team between the Navy, Army, and Air Force was developed to create a joint Internal Medicine manpower standard. The primary goals were to identify similarities and differences in standard development processes across the three services, develop joint processes (service-specific execution) with hopes of an integrated standard, and gain efficiencies through combination of knowledge, resources, and experience. To reach this goal, the team had multiple meetings/teleconferences to better understand each service's manpower requirements determination process, and concept of application and implementation guidelines. There were multiple Internal Medicine clinic sites visits through which the Tri-Service team identified similarities, differences, and lessons learned. From the above effort, it became clear that the services needed to all agree on productivity targets before moving forward in the clinical areas. The three services and DHA are currently in discussion to develop Tri-Service productivity targets for clinical areas. Moreover, the Military Health System Executive Review (MHSER) has endorsed minimum productivity levels for many clinical specialties. Since efforts are still ongoing within the services and the DHA, the recommendation should remain open. JULY 2015 UPDATE: According to a DHA Official, the Manpower and Personnel Operations Group was formed in early 2015. This group contains two subworking groups--one on manpower and the other on personnel. The overall group is working on a plan to develop common staffing models and an implementation plan to put them into action. At this time, the group's efforts are still in process and no common staffing models are in practice yet. Overall, the group is working on developing a minimum level of staffing needed in different specialties across the services. The group is also working on a Demand Based Staffing Model to help the enhanced-Multi Service Markets (eMSMs) to address the concern about the number of providers that are needed in these markets across the services to support the workload of the market. This model has been piloted at Peuget Sound, the NCR, and in Norfolk. It has also been briefed to the MDAG but it is not releasable at this time. Tis recommendation should remain open until such a time later that these groups have completed their initial work on models that will be used to more directly address the commons staffing requirements and the models.
    Recommendation: Consistent with DOD emphasis on developing human capital solutions across the services to enable departmentwide decision making and analyses within its Military Health System, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Service Secretaries to, where applicable, develop and implement cross-service medical manpower standards for those common medical capabilities.

    Agency: Department of Defense
    Status: Open

    Comments: Sept. 2014 Update: Since the issuance of our report in 2010, DOD officials established a Defense Health Agency as of October 1,2013, with the goal to take advantage of opportunities to adopt common business and clinical practices. Service and DHA officials have formed a joint collaborative team to develop standard manpower requirements as well as productivity goals for Internal Medicince capability area. Because they are still taking action related to this recommendation, it should remain open. JULY 2015: With the formation of the Manpower and Personnel Operations Group, HA, the services, and DHA continue to address staffing and manpower issues such as common staffing models. These are currently in development and none have been put into practice yet. The group is also developing a Demand Based Staffing Model to assist the enhanced Multi Service Markets (eMSMs) with determining the number and distribution of medical personnel within these markets. Until further work is done by the Operations Group, this recommendation will remain open.
    Director: Steinwald, Alan Bruce
    Phone: (202)512-3000

    1 open recommendations
    Recommendation: Given the contribution of physicians to Medicare spending in total, the Administrator of CMS should develop a profiling system that identifies individual physicians with inefficient practice patterns and, seeking legislative changes as necessary, use the results to improve the efficiency of care financed by Medicare. The profiling system should include methods for measuring the impact of physician profiling on program spending and physician behavior.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: Physician feedback reporting was initiated under section 131(c) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), and was expanded by section 3003 of the Patient Protection and Affordable Care Act (PPACA). In addition, PPACA required the Department of Health and Human Services to coordinate the physician feedback program with a Value Modifier (VM) that will adjust fee-for-service physician payments for the relative quality and cost of care provided to beneficiaries. In 2012, CMS provided Quality and Resource Use Reports (QRUR) to large providers nationwide and physician-focused QRURs to groups with 25 or more eligible providers in 9 states; by 2014, CMS sent QRURs to all group practices and solo practitioners. Also, as required in the act, CMS applied the VM to select physicians in 2015, with all physicians being subject to VM by 2017. The Act requires the VM to be implemented in a budget neutral manner, meaning that any upward payment adjustments for high performance must balance the downward payment adjustments applied for poor performance. CMS officials said they develop and will continue to develop experience reports related to each year's QRUR/VM cycle. In 2015, CMS used VM results for physicians in groups of 100 or more in public engagement of stakeholders, encouraging them to report quality, because quality performance was the driver of the payment adjustments in 2015. CMS is working with its Center for Clinical Standards and Quality to think of how to better engage physicians and groups in reporting, to avoid the automatic downward adjustment. As the program gains experience, CMS will use the experience reports to examine the impact of QRURs and VM on the Medicare program. In order for this recommendation to be closed as implemented, CMS will need to expand its efforts to measure the impact of QRURs and VM on program spending and physician behavior.
    Director: King, Kathleen M
    Phone: (312)220-7767

    1 open recommendations
    Recommendation: To better account for physicians practicing in underserved areas through the use of J-1 visa waivers, the Secretary of Health and Human Services should collect and maintain data on waiver physicians--including information on their numbers, practice locations, and practice specialties--and use this information when identifying areas experiencing physician shortages and placing physicians in these areas.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS's Health Resources and Services Administration (HRSA)is working with State Primary Care Offices (PCOs) to collect data to determine which geographic areas, population groups, and facilities are qualified and suitable to receive federal shortage designations. As part of this process, HRSA plans to have a list of the J-1 visa waiver providers who are providing patient care in underserved areas available after December 2016. As of September 2016, we are leaving this recommendation open until HRSA finishes collecting these data and finalizes plans on how the data will be used, particularly when identifying areas experiencing physician shortages and placing physicians in these areas.