From the U.S. Government Accountability Office, www.gao.gov

Transcript for: U.S. Comptroller General Testifies to House on
Management Challenges at Veterans Affairs

Description: In his February 28, 2023, testimony to the U.S. House
Committee on Veterans' Affairs, U.S. Comptroller General Gene L.
Dodaro, head of the GAO, testified on the management challenges at VA,
in areas including health care, acquisition management, disability
benefits, and cybersecurity. These longstanding challenges can affect
VA's current efforts to provide timely access to high quality care and
benefits.

Related GAO Works: GAO-23-106636

Released: February 2023

[ Gene Dodaro: ]

Good afternoon, Mr. Chairman. Representative Takano, Ranking Member,
and members of the committee. I'm very pleased to be here today to talk
about GAO's work regarding the Veterans Administration. VA is filled
with talented people, dedicated to their noble mission of serving our
veterans. However, they work in an unwieldy, highly decentralized
organization where efforts to bring about positive change are extremely
difficult to happen. In fact, many initiatives to make improvements
result in little, if any, meaningful change within the department.

As a result of observing this over a number of years, I added a number
of VA areas to a list we keep for the Congress of what we consider to
be high risk programs and activities there. These are programs where
there's waste, mismanagement or in need of broad based transformation.
So we've added veterans health care, the acquisition management area
and disability exams to this area. Now, in the health care area there
are a number of things we pointed out. First, there's a need for better
standards and measures to ensure timely access of veterans to the care
that they need. Also in the mental health and behavioral health area,
more analysis to provide services targeted to veterans in need of
intensive medical health services could be improved, particularly for
rural veterans.

Also, efforts to integrate behavioral health care into primary health
services, which is one of VA's strategies, has been hampered by a lack
of staff shortages, and more attention needs to be put in that area.
Also, oversight of long term care facilities needs to be improved, both
in the oversight of state nursing homes that VA provides funds to, as
well as VA's own community living centers. There also needs to be
greater attention to ensure there are enough providers in the networks
to provide care, and also that ineligible providers are rooted out and
not allowed to provide care in the system and that employees really
pass the background screening investigations that they must pass in
order to ensure the care of veterans and protect our veterans. And
also, as Mr. Missal mentioned, there is a need for much more
disciplined management practices to ensure the effective implementation
of the electronic health care records system.

Now on the acquisition management area, this area, there needs to be
better strategies to purchase medical and surgical supplies in a much
more efficient manner than there has been. There needs to be attention
to supply chain management, so not only what's purchased, but how it's
managed to get to the right places at the right time and also to make
sure you have an adequate workforce in the acquisition area that's
trained and competent to carry out their responsibilities to provide
the support necessary to give medical care to our veterans.

In the disability exams area, this is one of long standing concerns.
You know, we're still using the Veterans Department, you know, medical
criteria and earnings loss information based on a 1940s model. This
needs to be improved. VA has been working on it, their eight years
behind schedule and while there have been studies, there haven't been
improvements to the system. Also, there's a big backlog. There's about
80,000 cases from their legacy appeals process, which on average is
taking seven years to render an appeal. There's a 380,000 backlog in in
appeals under the new five option appeals process that they have. So as
a result of these legacy issues, they're not as well positioned as I
believe they need to be and could be in order to implement the PACT
Act. Now that's going to be a heavy lift for them. And they need to
learn from some of these past areas where they're not applying best
management practices to effectuate a good, efficient disability system
that ensures timely processing of original claims as well as the
appeals process going forward.

So we are dedicated at GAO to working with the Inspector General, with
the Veterans Department. I've noticed some improvement lately in our
efforts to get agreement of what needs to be done with the department.
So I see some glimmers of progress, but that's only the beginning. And
there's a long way necessary to really bring about the type of change
that our veterans deserve. So I'd be happy to answer questions at the
appropriate point.

[ End ]

For more info, check out our report GAO-23-106636 at: GAO.gov