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    Results:

    Subject Term: "Veterans hospitals"

    18 publications with a total of 48 open recommendations including 4 priority recommendations
    Director: Williamson, Randall B
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: The Under Secretary for Health should specify in VHA policy that reviews of providers' clinical care after concerns have been raised should be documented, including retrospective and comprehensive reviews. (Recommendation 1)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Under Secretary for Health should specify in VHA policy a timeliness requirement for initiating reviews of providers' clinical care after a concern has been raised. (Recommendation 2)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Under Secretary for Health should require VISN officials to oversee VAMC reviews of providers' clinical care after concerns have been raised, including retrospective and comprehensive reviews, and ensure that VISN officials are conducting such oversight with the required standardized audit tool. This oversight should include reviewing documentation in order to ensure that these reviews are documented appropriately and conducted in a timely manner. (Recommendation 3)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Under Secretary for Health should require VISN officials to establish a process for overseeing VAMCs to ensure that they are reporting providers to the NPDB and SLBs, and are reporting in a timely manner. (Recommendation 4)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Shelby S. Oakley
    Phone: (202) 512-4841

    10 open recommendations
    Recommendation: The Director of the MSPV-NG program office should, with input from the Strategic Acquisition Center (SAC), develop, document, and communicate to stakeholders an overarching strategy for the program, including how the program office will prioritize categories of supplies for future phases of requirement development and contracting. (Recommendation 1)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Veterans Health Administration (VHA) Chief Procurement and Logistics Officer should take steps to prioritize the hiring of the MSPV-NG program office's director position on a permanent basis. (Recommendation 2)

    Agency: Department of Veterans Affairs
    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 Veterans Affairs should assign the role of Chief Acquisition Officer to a non-career employee, in line with statute. (Recommendation 3)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Director of the MSPV-NG program office should provide complete guidance to medical centers for matching equivalent supply items, which could include defining the roles of clinicians and local Clinical Product Review Committees. (Recommendation 4)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Director of the MSPV-NG program office should, with input from SAC, communicate to medical centers the criteria and processes for adding or removing items from the formulary. (Recommendation 5)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The VHA Chief Procurement and Logistics Officer, in coordination with SAC, should calculate cost avoidance achieved by MSPV-NG on an ongoing basis. (Recommendation 6)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The MSPV-NG program office and SAC should establish a plan for how to mitigate the potential risk of gaps in contract coverage while SAC is still working to make competitive Phase 2 awards, which could include prioritizing supply categories that are most likely to yield cost avoidance. (Recommendation 7)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The VHA Chief Procurement and Logistics Officer should use input from national clinical program offices to prioritize its MSPV-NG requirements development and standardization efforts beyond Phase 2 to focus on supply categories that offer the best opportunity for standardization and cost avoidance. (Recommendation 8)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The VHA Chief Procurement and Logistics Officer should direct Veterans Integrated Service Network (VISN) Network Contracting Offices to work with medical centers to identify any opportunities to more strategically purchase goods and services frequently purchased on an emergency basis. For example, offices could do this by analyzing existing data. (Recommendation 9)

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: VHA Chief Procurement and Logistics Officer should analyze data on items that are frequently purchased on an emergency basis, determine whether such items are suitable to be added to the MSPV-NG formulary, and work with SAC to make any suitable items available via MSPV-NG. (Recommendation 10)

    Agency: Department of Veterans Affairs
    Status: Open

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

    2 open recommendations
    Recommendation: The Undersecretary for Health should take additional steps to ensure that VA's website reports health care quality measures that cover a broad range of health care services, highlights key differences in the clinical quality of care, and presents this information in an easily accessible and understandable way (Recommendation 1).

    Agency: Department of Veterans Affairs
    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 direct VA Central Office to conduct a systematic assessment of the completeness and accuracy of patient clinical information across VAMCs that is used to calculate the health care quality measures VA reports and address any deficiencies that affect the accuracy of these measures (Recommendation 2).

    Agency: Department of Veterans Affairs
    Status: Open

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

    4 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Acting Under Secretary for Health to develop and disseminate a system-wide standard operating procedure that clearly defines the roles and responsibilities of VAMCs in resolving pending enrollment applications.

    Agency: Department of Veterans Affairs
    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 Veterans Affairs should direct the Acting Under Secretary for Health to clearly define oversight roles and responsibilities for HEC, and for Veterans Integrated Service Networks as appropriate, to help ensure timely processing of applications and accurate enrollment determinations.

    Agency: Department of Veterans Affairs
    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 Veterans Affairs should direct the Acting Under Secretary for Health to develop procedures for collecting consistent and reliable data system-wide to track and evaluate timeliness of enrollment processes, and institute an oversight mechanism to ensure VAMC and HEC enrollment staff are appropriately following the procedures.

    Agency: Department of Veterans Affairs
    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 Veterans Affairs should direct the Acting Under Secretary for Health to clarify its 5-day timeliness standard for processing enrollment applications, including whether it covers the total time needed to make an enrollment determination and the time applications are pending, and ensure the clarification is communicated system-wide.

    Agency: Department of Veterans Affairs
    Status: Open

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

    4 open recommendations
    Recommendation: To improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to expand existing productivity metrics to track the productivity of all providers of care to veterans by, for example, including contract physicians who are not VA employees as well as advance practice providers acting as sole providers.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to help ensure the accuracy of underlying staffing and workload data by, for example, developing training to all providers on coding clinical procedures.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to develop a policy requiring VAMCs to monitor and improve clinical efficiency through a standard process, such as establishing performance standards based on VA's efficiency models and developing a remediation plan for addressing clinical inefficiency.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to establish an ongoing process to systematically review VAMCs' remediation plans and ensure that VAMCs and Veterans Integrated Service Networks are successfully implementing remediation plans for addressing low clinical productivity and inefficiency.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Wise, David J
    Phone: (202) 512-2834

    2 open recommendations
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to address identified limitations to the SCIP process, including limitations to scoring and approval, and access to information.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA partially concurred with this recommendation. In their 60-day letter dated August 3, 2017, VA noted that it has made process changes in those areas that it concurred with. This includes both access to information, improving communication and timing of SCIP results, and lessoning the administrative burden of providing SCIP documents to SCIP users. For fiscal year (FY) 2018 SCIP, including the projects that were funded, the results were provided prior to the 2018 budget release, and prior to the development of SCIP 2019 business cases. In the past, these results were not released to planners until after the budget was publicly released. In addition, the threshold for inclusion of projects into the SCIP process was raised from $1 M to $3M for the Veterans Health Administration (VHA) nonrecurring maintenance (NRM) projects. This was done to lessen the administrative burden and provide more flexibility to the field to manage their operational needs. Although VA has made some progress towards this recommendation, they have not satisfied the full intent. Specifically, VA has not yet made changes to improve the visibility and prioritization of sequenced projects or the scoring and approval process. VA noted that it disagreed that the SCIP scoring and approval process introduces subjectivity through the use of its business cases, but we will follow up over the next year to see if they made any changes that would help address this portion of the recommendation.
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to assess the value of VAIP's facility master plans as a facility-planning tool. Based on conclusions from the review, either 1) discontinue the development of VAIP's facility master plans or 2) address the limitations of VAIP's facility master plans.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day letter dated August 3, 2017, VA noted that its VAIP facility master plans have been discontinued while VA pursues a congressionally-directed National Realignment Strategy, which will last a minimum of 18 months. VA will be evaluating service delivery opportunities in each contiguous United States (CONUS) market, to improve the networks of complementary community care providers, best coordinate Veteran healthcare, and move certain components of care into the community when appropriate. Once a National Realignment Plan is submitted and approved by Congress, future facility master plans will be adjusted accordingly, and incorporate pertinent information. Such information will include community care realignment opportunities. We will follow-up with VA to obtain additional information regarding this recommendation.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to conduct a cost-effectiveness analysis for the FHCC to establish a baseline for measuring the facility's efficiency over time.

    Agency: Department of Defense
    Status: Open

    Comments: As of September 2017, VA and DOD had a projected date for a cost-effectiveness analysis of June 2018. We will follow up at that time.
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to conduct a cost-effectiveness analysis for the FHCC to establish a baseline for measuring the facility's efficiency over time.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of September 2017, VA and DOD had a projected date for a cost-effectiveness analysis of June 2018. We will follow up at that time.
    Director: Debra Draper
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to conduct an evaluation of the implementation of the VISN realignment to determine whether deficiencies exist that need corrective actions, and apply lessons learned from the evaluation to future organizational structure changes, such as possible changes to VISN staffing models or actions to implement Commission on Care recommendations.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. In July 2017, VHA told us that a Rapid Design and Implementation functional assessment of VHA Central Office and VISN organizations had been completed, which included a survey, interviews with central office and VISN officials, and other meetings. In November 2017, VHA reported that in October it awarded a contract to conduct an independent assessment of the VISN consolidation experience and to make recommendations for future actions. The independent assessment is expected to be completed in January 2018. VHA also reported in November 2017 that the Rapid Design and Implementation functional assessment process yielded a high-level organizational concept that is being used by teams to develop recommendations for consolidations within VHA, and that these recommendations will be submitted to VHA leadership in January 2018. In our recommendation, we stated that lessons learned from evaluating the VISN realignment need to be applied to future organizational structure changes. It is difficult to determine at this time how lessons learned from the VISN realignment's evaluation can be incorporated into new organizational structure changes if such changes are being drafted for VHA leadership approval at the same time that the evaluation is underway. As of December 2017, this recommendation remains open pending further updates from VHA.
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a process to ensure that organizational structure recommendations resulting from internal and external reviews of VHA are evaluated for implementation. This process should include the documentation of decisions and assigning officials or offices responsibility for ensuring that approved recommendations are implemented.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. Earlier in 2017, VHA reported that its initial work on this recommendation was paused to allow the Agency to respond to President Trump's Executive Order dated March 13, 2017, on "Comprehensive Plan for Reorganizing the Executive Branch." VHA resumed work on this recommendation once the VA Modernization Initiative evaluated and approved the results of a VHA Rapid Design and Implementation that generated a revised VHA functional chart. In November 2017, VHA reported that the Acting Under Secretary for Health approved a new procedure for documenting and implementing organizational changes on July 12, 2017, and provided a copy. The standard operating procedure contains specific instructions and mechanisms for evaluating, recording, promulgating and implementing proposed organizational changes. VHA further reported that the procedure will be applied to implementing organizational structure changes proposed as part of operationalizing the revised VHA functional chart. VHA anticipated that the first proposal using the new organizational changes procedure will be submitted to senior VHA leadership for approval in January 2018. As of December 2017, this recommendation remains open pending further updates from VHA.
    Director: Shea, Rebecca
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To enhance transparency and allow for more informed decision making related to VA's major medical facility leases, the Secretary of Veterans Affairs should annually assess how VA has benefited from flexibilities afforded by leasing its major medical facilities and use information from these assessments in its annual capital plans.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On September 30, 2016, VA reported to GAO that as VA develops its fiscal year 2018 Budget Request to Congress, the Department will continue assessing the benefits of its major medical lease program and will include the related documentation in its capital budget request.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help provide reasonable assurance that VHA achieves its long-term goal of modernizing its claims processing system, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that the agency develops a sound written plan that includes the following elements: (1) a detailed schedule for when VHA intends to complete development and implementation of each major aspect of its new claims processing system; (2) the estimated costs for implementing each major aspect of the system; and (3) the performance goals, measures, and interim milestones that VHA will use to evaluate progress, hold staff accountable for achieving desired results, and report to stakeholders the agency's progress in modernizing its claims processing system.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: As of June 2017, VHA's Office of Community Care is in the process of consolidating VA's community care programs, and as part of this process it plans to transition to a third party administrator for the purposes of claims processing. While an active procurement is underway, VHA still needs to develop a written plan to fully implement this recommendation. VHA's written plan must include details about the schedule, cost estimates, performance goals, and interim milestones associated with transitioning to a third party administrator for the purposes of processing claims for VA community care.
    Director: Williamson, Randall B
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To develop and maintain medical sharing expertise within the network contracting offices, the Secretary of Veterans Affairs should direct the Under Secretary for Health to create a plan for increasing the retention of contracting officers that work in medical sharing teams.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In March 2017, VHA reported that it is working on creating a plan for increasing the retention of contracting officers that work in medical sharing teams. The Medical Sharing Office (MSO) has taken several steps including conducting research on possible ways to minimize or eliminate steps within its existing plan and expanding the number of topical training provided virtually network contracting offices to develop competency in VHA Health Care 1102 staff. In addition, VHA reported they are developing a training schedule to ensure newly deployed interns have received the training and resource to successfully conduct health care contracts if they are assigned to health care resources team and continuing to collaborate with the field to ensure awareness of MSO support and assistance.
    Recommendation: To ensure VHA effectively communicates with its affiliates regarding SSACs, the Secretary of Veterans Affairs should direct the Under Secretary for Health to reach out to all of its affiliates, identify any concerns, and determine the most effective method of communicating with affiliates regarding SSAC development.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In March 2017, the VHA reported that it plans to have an Academic Affiliate Contracting Forum on August 15-16, 2017 in Nashville, TN or Dallas, TX for VHA staff responsible for health care contracts and University affiliates. The purpose of the Forum is to strengthen and advance the collaborative partnership for providing service to Veterans; share perspectives; and enhance awareness about processes, procedures and tools that will help make contracting processes faster and easier for all parties.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to monitor the full amount of time newly enrolled veterans wait to be seen by primary care providers, starting with the date veterans request they be contacted to schedule appointments. This could be accomplished, for example, by building on the data collection efforts currently being implemented under the "Welcome to VA" program.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: In March 2016, GAO recommended that VA monitor the full amount of time newly enrolled veterans wait to be seen by primary care providers, starting with the date veterans request they be contacted to schedule appointments. VA concurred with this recommendation, and in June 2017, reported to GAO that it had taken actions to address this recommendation. Specifically, VA indicated that it revised an internal report to help identify and document all newly enrolled veterans and monitor their appointment request status. The report is intended to enable VHA and its medical centers to oversee the enrollment and appointment process by tracking the following timeframes: (1) application to enrollment, (2) enrollment to initial contact, (3) initial contact to primary care appointment, and (4) total time from application from appointment. However, VA also indicated in its response that it does not have data that captures application dates for all newly enrolled veterans. As a result, this report cannot be used to consistently monitor the full amount of time these veterans wait to be seen by primary care providers. To fully implement this recommendation VA needs to capture the application date for all newly enrolled veterans. Upon receiving further information about how and when VA plans to capture this information, we will assess whether VA's actions are sufficient to warrant closure of this recommendation.
    Director: Debra Draper
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Secretary of Defense should direct the Secretary of the Army to implement processes to review and monitor the Army military treatment facility prescribing practices for medications discouraged under the PTSD guideline and address identified deviations.

    Agency: Department of Defense
    Status: Open

    Comments: We requested an update on the status of this recommendation. As of June 21, 2016, we are waiting for a response from DOD.
    Director: Debra Draper
    Phone: (202) 512-7114

    2 open recommendations
    including 1 priority recommendation
    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 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: 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: Steve Lord
    Phone: (202) 512-6722

    1 open recommendations
    Recommendation: In order to improve the quality of the data collected on specific land-use agreements (i.e., sharing, outleases, licenses, and permits), enhance the monitoring of its revenue process and monitoring of agreements, and improve the accountability of the VA in this area, the Secretary of Veterans Affairs should develop mechanisms to monitor the billing and collection of revenues for land-use agreements to help ensure that transactions are promptly and accurately recorded at the three medical centers.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: Veterans Affairs-Veterans Health Administration officials are currently updating their policies on Sharing Use of Space. Veterans Affairs-Veterans Health Administration Office of Enterprise Management will provide support to the agency's office of Finance, as needed, on the process for recognition of revenue, billing, collections, and for financial reporting to ensure completeness of financial data for land use agreements. Agency officials began working on the Capital Asset Inventory validation report. Upon completion, the report will be provided to agency field staff for action on updating the database.
    Director: Williamson, Randall B
    Phone: (202) 512-7114

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To effectively manage fee basis care spending, the Secretary of Veterans Affairs should revise the beneficiary travel eligibility regulations to allow for the reimbursement of travel expenses for veterans to another VAMC to receive needed medical care when it is more cost-effective and appropriate for the veteran than seeking similar care from a fee basis provider.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of September 2015, VA has taken some actions to address this recommendation, but additional actions are needed to fully implement it. We will update the status of this recommendation when we receive additional information from VA.
    Recommendation: To effectively manage fee basis care wait times and spending, the Secretary of Veterans Affairs should direct the Under Secretary for Health to analyze the amount of time veterans wait to see fee basis providers and apply the same wait time goals to fee basis care that are used as VAMC-based wait time performance measures.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: In October 2014, VHA established a new wait-time goal, which is that veterans should be seen within 30 days of the date that an appointment is deemed clinically appropriate by a VA health care provider, or if no such clinical determination has been made, the date a veteran prefers to be seen for hospital care or medical services. While VHA has been monitoring the timeliness of VHA-based care according to this standard, it has not been applying the same standard to community-based care, including care delivered through the Veterans Choice Program. Therefore, VHA cannot determine whether veterans are receiving care in the community sooner or later than they otherwise would receive care at VA medical facilities. To fully implement this recommendation, VHA needs to take steps to ensure that its wait-time policies and procedures for both VHA-based care and community-based care (fee basis care) are aligned.
    Recommendation: To ensure that VA Central Office effectively monitors fee basis care, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that fee basis data include a claim number that will allow for VA Central Office to analyze the episode of care costs for fee basis care.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of September 2015, VA has taken some actions to address this recommendation, but additional actions are needed to fully implement it. We will update the status of this recommendation when we receive additional information from VA.