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: In its comments to this recommendation, DOD concurred with this recommendation and said that the database was inoperable but that it was being reviewed as part of a multi-year information technology modernization effort to transition all military medical records to a new system known as MHS (Military Health System) GENESIS. They noted that the capability for USMEPCOM to conduct EPTS medical records review would be available within MHS GENESIS' business intelligence tools once implemented. When asked about the status of any actions taken to address this recommendation by preparing a schedule as to when this internal database would be repaired, DOD responded in January 2018 that USMEPCOM is unable to expend any funds to repair or replace the EPTS database system as this functionality is to be incorporated into the upcoming MHS GENESIS program. DOD officials confirmed that USMEPCOM's initial site testing will occur in FY 2019. While DOD officials are not able to repair its current internal database needed to complete its statistical analysis of these particular medical records, MHS GENESIS will be able to provide USMEPCOM with this capability. In August 2019, a senior DOD official confirmed that using MHS GENESIS is still the primary course of action to address this recommendation. He said that its implementation is planned for 2020/2021; however, there has been another delay and the department is waiting for a new implementation date to be established. In May 2020, this same official provided updated information that said MHS Genesis was delayed until 2021. Therefore, until further progress is made in implementing MHS GENESIS, this recommendation should remain open.

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: In its comments to this recommendation, DOD partially concurred and stated that it began fielding MHS GENESIS and anticipated issuing a Full Deployment Decision (FDD) certification in 2018 to proceed to the remaining sites. Further, when asked about the status of any actions taken to address this recommendation, DOD responded in January 2018 that USMEPCOM's inclusion in MHS GENESIS is scheduled for approval in late fiscal year 2018 with initial MEPS site testing in fiscal year 2019. According to DOD, USMEPCOM officials are working closely with the program management officials and the MHS GENESIS team to develop information requirements for approval and inclusion in the MHS GENESIS deployment plan once FDD is granted. The estimated completion date for the roll out to all remaining MEPS locations is fiscal year 2021. In August 2019, a senior DOD official confirmed that the department's primary course of action for addressing this recommendation remains the use of MHS GENESIS. However, he said that DOD has experience a delay and in May 2020, he stated that MHS Genesis had been delayed until FY 21. Given that DOD is still in the process of deploying MHS GENESIS, we believe this recommendation should remain open until progress has been made in implementing the MHS Genesis within the MEPS locations.

Recommendation: To ensure that savings are realized from the implementation of an MPPR or other policies that reflect efficiencies occurring when services are furnished together, Congress may wish to consider exempting these savings from budget neutrality.

Agency: Congress
Status: Open

Comments: Congress has exempted savings from the implementation of multiple procedure payment reductions (MPPR) for certain diagnostic imaging and therapy services from the budget neutrality requirement, as GAO suggested in July 2009. However, as of January 2020, other policies that may result in a reduction in payments for the professional component for imaging services remained subject to budget neutrality; "savings" from these services are redistributed to other services and do not accrue to the Medicare program. The Consolidated Appropriations Act of 2016 revised the payment reduction for the professional component of multiple diagnostic imaging services from 25 percent to 5 percent beginning on January 1, 2017, and exempted the reduced expenditures attributable to this MPPR from the budget neutrality provision. MPPRs or other policies that may result in a reduction to payments for the technical component for diagnostic cardiovascular and ophthalmology services continue to be subject to budget neutrality for 2020. Unless Congress exempts from the budget neutrality requirement savings realized from the implementation of all MPPRs or other policies that reflect efficiencies occurring when services are furnished together, these savings will not accrue to the Medicare program.