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Highlights

GAO reviewed Veterans Administration (VA) hospitals to determine whether VA: (1) was effectively managing its medical and surgical patients; and (2) could more efficiently reduce the length of stay for these patients.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Veterans Administration 1. The Administrator of Veterans Affairs should direct the Chief Medical Director to revise current policies to place greater emphasis on reducing surgery delays and turnaround times for diagnostic consultations, tests, and procedures. In making these revisions, the Chief Medical Director should make the current policies and goals more specific, using such guidelines as those developed by the American Hospital Association.
Closed - Implemented
VA issued a policy circular regarding the utilization review issues GAO raised.
Veterans Administration 2. The Administrator of Veterans Affairs should direct the Chief Medical Director to develop reports at the VA central office and at individual hospitals to identify length of stay problems and those responsible for solving them. These reports could include such analyses as: (1) a comparison of length of stay by selected diagnosis categories at each VA hospital; (2) a comparison of length of stay for each physician's patients in a particular medical or surgical specialty; and (3) a list of patients who have been in the hospital for more than 30 days.
Closed - Not Implemented
VA does not concur with this recommendation and plans no action.
Veterans Administration 3. The Administrator of Veterans Affairs should direct the Chief Medical Director to require hospitals to use explicit patient screening criteria, such as those addressing intensity of care or severity of illness, to evaluate the appropriateness of the level of treatment.
Closed - Implemented
A national education program on utilization review management was conducted between March 1986 and September 1986.
Veterans Administration 4. The Administrator of Veterans Affairs should direct the Chief Medical Director to require hospitals to staff their utilization review function with qualified people, including reviewers who have a medical background.
Closed - Not Implemented
VA agreed with the intent of this recommendation, but refused to tell hospitals who to hire. This will be reviewed as part of the facility's SERP review.
Veterans Administration 5. The Administrator of Veterans Affairs should direct the Chief Medical Director to require hospitals to conduct all three types of review, concurrent, retrospective, and focused, as part of their utilization review program. Concurrent reviews should be conducted shortly after the patient's admission and periodically throughout the patient's stay. Retrospective reviews should be conducted after patients have been discharged so that the hospital can ensure whether such patient management practices as preadmission testing and discharge planning were carried out. Focused reviews should be conducted either concurrently or retrospectively.
Closed - Not Implemented
VA contended that each facility should be allowed to decide when, and to what degree, the reviews should be performed. The revised manual will describe each type of review and allow the centers to choose which to follow.
Veterans Administration 6. The Administrator of Veterans Affairs should direct the Chief Medical Director to include criteria on the key elements of utilization review in the Standards, Criteria, Evaluative Algorithms, and Measuring Instruments. SERP teams should use the criteria when evaluating each hospital's utilization review program.
Closed - Implemented
A section on utilization review was included in SCEM during the fourth quarter in fiscal year 1985.
Veterans Administration 7. The Administrator of Veterans Affairs should direct the Chief Medical Director to increase the scope of SERP by including evaluations of a random sample of patient case files at each hospital. These evaluations would help measure the effectiveness of hospitals' efforts to minimize lengths of stay and would also help measure the effectiveness of hospitals' utilization review programs. To identify potential length of stay problems, the external review team can use reports and data such as those described above.
Closed - Not Implemented
VA disagreed, stating that there was not enough time during SERP reviews for physicians to review length of stay issues. However, VA is implementing several other systems, including MEDIPRO, which may achieve the same objective.

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