VA Disability Exams: Improved Performance Analysis and Training Oversight Needed for Contracted Exams
What GAO Found
The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency's quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors' quality scores fell well below VBA's target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information.
Disability Compensation Medical Exams Completed by Contractors, Fiscal Years 2012-2018
VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA's quality and timeliness information limit VBA's ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.
A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.
Why GAO Did This Study
In 2016, VBA awarded 12 contracts to five private firms for up to $6.8 billion lasting up to 5 years to conduct veterans' disability medical exams. Both VBA contracted medical examiners and medical providers from the Veterans Health Administration perform these exams, with a growing number of exams being completed by contractors. Starting in 2017, VBA contracted examiners conducted about half of all exams. GAO was asked to review the performance and oversight of VBA's disability medical exam contractors.
This report examines (1) what is known about the quality and timeliness of VBA contracted exams; (2) the extent to which VBA monitors contractors' performance; and (3) how VBA ensures that its contractors provide qualified and well-trained examiners. GAO analyzed the most recent reliable data available on the quality and timeliness of exams (January 2017 to February 2018), reviewed VBA and selected contract documents and relevant federal laws and regulations, and interviewed agency officials, exam contractors, an audit firm that checks examiners' licenses, and selected veterans service organizations.
GAO recommends VBA (1) develop a plan for using its new data system to monitor contractors' quality and timeliness performance, (2) analyze overall program performance, (3) verify that contracted examiners complete required training, and (4) collect information to assess the effectiveness of that training. The Department of Veterans Affairs agreed with GAO's recommendations.
Recommendations for Executive Action
|Department of Veterans Affairs||The Under Secretary for Benefits should develop and implement a plan for how VBA will use data from the new exam management system to oversee contractors, including how it will capture accurate data on the status of exams and use it to (1) assess contractor timeliness, (2) monitor time spent correcting inadequate and insufficient exams, and (3) verify proper exam invoicing. (Recommendation 1)||
VBA developed and implemented a plan for using its new Exam Management System (EMS) to improve oversight of contractor performance. VBA has performed various updates to align EMS with other VA and contractor systems, and, in April 2021, VBA reported that it now produces reports with the timeliness data needed to oversee contractor performance. To help assess contractor timeliness and monitor time spent correcting exams, VBA created separate data elements in EMS to track the status of original exam requests and any related rework requests due to insufficient exam reports. Thus, VBA can now assess how much time contractors took to complete the original exam request and monitor time spent correcting any insufficient exam reports. To help verify proper invoicing, VBA started using EMS data to conduct monthly invoice validation reviews to identify and resolve any potential billing errors made by contractors
|Department of Veterans Affairs||The Under Secretary for Benefits should regularly monitor and assess aggregate performance data and trends over time to identify higher-level trends and program-wide challenges. (Recommendation 2)||
VBA established a new data analytics team within its contract exam program office in October 2020 that is dedicated to monitoring and assessing contractor performance data. The data analytics team produces daily, weekly, and monthly performance reports with a variety of performance indicators that allow VBA to monitor trends in both individual contractor and program-wide performance. For example, VBA's daily performance snapshots include data on average days pending and average days to complete exams (by contractor and region), the number of pending exams associated with backlogged disability claims, and the number of exams cancelled by contractors, among other indicators. Further, a senior VBA official stated in May 2021 that the data analytics team provided essential real-time analysis of exam capacity challenges during the COVID-19 pandemic that helped inform VBA's efforts to address its disability claims backlog.
|Department of Veterans Affairs||The Under Secretary for Benefits should document and implement a plan and processes to verify that contracted examiners have completed required training. (Recommendation 3)||
VA agreed with this recommendation. The agency stated that VBA has started developing a training plan for contractors, as well as a new training delivery system, to validate that required training has been completed and to assess the effectiveness of this training through feedback from trainees, contractors, and quality review staff in VBA's contract exam program office. VBA intends to use this information to improve the implementation and content of training. VBA expects to fully implement its new training system by December 31, 2021. In the interim, VBA said that it will continue to conduct compliance audits of contractors to ensure they track completion of training by examiners. GAO will close this recommendation once VBA implements its new training delivery system that will allow it to determine whether all examiners have completed required training prior to conducting disability medical exams. As of July 2022, we await more information on the agency's progress.
|Department of Veterans Affairs||The Under Secretary for Benefits should collect information from contractors or examiners on training and use this information to assess training and make improvements as needed. (Recommendation 4)||
In January 2022, VBA implemented a centralized online training system for contracted examiners. VBA uses this new system, in part, to collect feedback from examiners after each training course they complete. VBA also developed an annual training evaluation plan for collecting information from examiners and other contract exam program stakeholders regarding the adequacy of training at various points following the training. In August 2022, VBA completed an evaluation of examiner feedback on all required training courses and documented changes that the agency made to individual courses and to its training evaluation plan based on the feedback.