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As of January 31, 2023, there are 4840 open recommendations that still need to be addressed. 471 of these are priority recommendations, those that we believe warrant priority attention. Learn more about our priority designation on our Recommendations page.

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1 - 15 of 15 Recommendations, including 2 Priority Recommendations

Veterans Health Care: Staffing Challenges Persist for Fully Integrating Mental Health and Primary Care Services

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2 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The Under Secretary for Health should ensure that the Office of Mental Health and Suicide Prevention monitors VISNs' development and implementation of corrective action plans for any VHA facilities that do not fully adhere to VHA's Primary Care Mental Health Integration program requirements. (Recommendation 1)
Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Veterans Health Administration The Under Secretary for Health should ensure that the Office of Mental Health and Suicide Prevention comprehensively evaluate and implement strategies to help mitigate staffing challenges that affect VHA facilities' abilities to integrate mental health care within primary care settings. (Recommendation 2)
Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

VA Health Care: Additional Action Needed to Assess the Medical Scribe Pilot

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1 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The Under Secretary for Health should assess the scalability of the medical scribe pilot, including identifying and applying criteria to inform decisions about whether or how to use scribes beyond the pilot. (Recommendation 1)
Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

VA Vet Centers: Opportunities Exist to Help Better Ensure Veterans' and Servicemembers' Readjustment Counseling Needs Are Met

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5 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The RCS Chief Officer should develop and implement a process to periodically assess the extent to which Vet Centers are meeting the needs of their clients collectively, including subpopulations of clients that may experience different challenges readjusting to civilian life or to continued military service. Such client subpopulations could include those who experienced trauma during military service and those who served in different conflicts. (Recommendation 1)
Open

VA concurred with this recommendation. In April 2022, RCS officials reported that data from RCS's Vet Center client feedback survey can be used to analyze how Vet Center services are meeting the needs of individuals served, and these data can be filtered in several ways, such as by client demographic characteristics (e.g., race, gender, age, branch of service, etc.) and organizational levels (e.g., RCS overall, Districts, Vet Centers). RCS officials stated RCS received enough survey response to conduct a macro-level analyses and more survey responses are needed to analyze demographic subsets

Veterans Health Administration The RCS Chief Officer should ensure that Vet Centers have data on eligible individuals in their service area that they can use to tailor their outreach activities. These data could include information on veterans who have recently transitioned back from military service and veterans' demographic characteristics (e.g., age, gender, race, and ethnicity). (Recommendation 2)
Open

VA concurred with this recommendation. In April 2022, RCS officials reported that they intend to work with the Department of Defense to obtain data on veterans who recently transitioned from active service by zip code and provide it to Vet Centers to use for outreach. RCS officials also reported that they are working to provide Vet Centers with county-level data on their veteran populations and data on the demand for readjustment counseling services in their service areas. As of August 2022, RCS officials reported that they are continuing to evaluate and develop these processes, with a planned

Veterans Health Administration The RCS Chief Officer should provide Vet Centers with guidance for assessing the effectiveness of their outreach activities. This guidance should include metrics for the outreach activities and targets against which to assess those metrics to determine effectiveness. (Recommendation 3)
Open

VA concurred with this recommendation. In April 2022, RCS officials reported that they are working to define and measure effective outreach. RCS officials stated they are assessing their current outreach practices and considering practices used by external organizations that have demonstrated outreach success. They also reported that RCS intends to develop metrics and refine its data collection processes for measuring outreach effectiveness and, once finalized, the data will be provided to Vet Centers to use to assess and monitor outreach activities. As of August 2022, RCS officials reported

Veterans Health Administration The RCS Chief Officer should develop and implement a process to periodically assess the extent of identified barriers eligible veterans and servicemembers may experience to obtaining services, including a lack of awareness about Vet Centers and challenges accessing Vet Center services. (Recommendation 4)
Open

VA concurred with this recommendation. In April 2022, RCS officials reported that they will use results from RCS's Vet Center client feedback survey to understand barriers eligible individuals experience to accessing Vet Center services. They also provided guidance for analyzing the survey results to RCS District Offices. RCS officials also stated they will explore partnerships with other VA offices and stakeholders to develop and implement a process to assess eligible individuals' awareness of Vet Center services. In August 2022, RCS officials reported that VHA will contract externally to

Veterans Health Administration The RCS Chief Officer should develop and implement a process to periodically assess the extent of identified barriers Vet Center staff may encounter to providing services, including challenges obtaining clinical consultations for complex cases. (Recommendation 5)
Open

VA concurred with this recommendation. In April 2022, RCS officials reported that they currently obtain some information about barriers Vet Center staff may encounter to providing services through existing survey processes, including training needs assessments and an annual employee survey, and from clinical oversight site visits conducted by RCS District Office staff. RCS officials also stated that they plan to evaluate the potential for including more specific questions about barriers to staff providing services in existing surveys. They stated that if doing so is not feasible, they will

VA Health Care: Clinical Contact Center Modernization Could Benefit from a Shared Schedule and Additional Guidance to Networks

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1 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The Under Secretary for Health should update and share a schedule with networks for the Clinical Contact Center Modernization effort beyond December 31, 2021, which includes (1) milestones, (2) captures all activities, (3) sequences all activities, and (4) establishes the duration of all activities. (Recommendation 1)
Open

In May 2022, the Veterans Health Administration (VHA) reported that it actively collaborated with networks to develop milestones and expectations beyond December 31, 2021. These milestones are documented in the Integrated Master Schedule (IMS) in addition to the sequence and duration of necessary activities. VHA reported that it shared the IMS with networks on March 31, 2022; we are awaiting documentation of this to close the recommendation.

Freedom of Information Act: Actions Needed to Improve Agency Compliance with Proactive Disclosure Requirements

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1 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The VA Under Secretary for Health should track the number of proactive disclosures for all required categories and report this information in VA's Annual FOIA Report. (Recommendation 6)
Open

As of August 2021, VHA has made progress on this recommendation by issuing finalized standard operating procedures that provided instructions for tracking proactively disclosed records including operational documents. Additional actions are needed because the standard operating procedures do not address how the agency is to track and report the number of proactive disclosures by program offices for all required categories, as required by FOIA. VHA stated that they will be asking program offices for this information. We will continue to monitor VHA's progress and follow-up with them as

Veterans Health Care: VA Needs to Improve Its Allocation and Monitoring of Funding

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1 Open Recommendations
1 Priority
Agency Recommendation Status
Veterans Health Administration
Priority Rec.
This is a priority recommendation.
The VA Under Secretary of Health should revise its existing guidance to require VISNs—in conjunction with medical centers—to develop and submit approaches to improve efficiency at medical centers with declining workload that received adjusted funding levels. These approaches could include adjusting the level of services offered. (Recommendation 4)
Open

VA agreed in principle with our recommendation. In December 2021, VHA said that after completing the market assessments and reviewing information from other VHA efforts, it may consider adjusting the level of services offered at VA medical centers, along with other alternatives. In addition, VHA said that the Assistant Under Secretary for Health for Operations continues to review the ongoing work of Veterans Integrated Service Network directors to align resources with workload. VHA expects to complete these efforts in early 2022.

VA Nursing Home Care: VA Has Opportunities to Enhance Its Oversight and Provide More Comprehensive Information on Its Website

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1 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The Under Secretary of Health should provide information on the quality of all SVHs that is comparable to the information provided on the other nursing home settings on its Access to Care website. (Recommendation 4)
Open

VA concurred in principle and, as of July 2021, added information about SVHs on its Access to Care website, including information for the two-thirds of SVHs that are on Nursing Home Compare. VA stated they would continue to improve the SVH information, but that these actions would take time. We will continue to monitor VA's efforts to improve comparability of SVH information on its website.

VA Health Care: Improved Oversight Needed for Reusable Medical Equipment

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1 Open Recommendations
Agency Recommendation Status
Veterans Health Administration The Under Secretary of Health should examine the Sterile Processing Services workforce needs and take action based on this assessment, as appropriate. (Recommendation 3)
Open

VA agreed with this recommendation and indicated it would review workforce needs and take necessary actions. VA has described some of the actions taken and in a May 2022 update noted that actions would be completed in fall 2022. We will update the status of this recommendation when additional information is received.

Veterans Health Administration: Better Data and Evaluation Could Help Improve Physician Staffing, Recruitment, and Retention Strategies

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2 Open Recommendations
1 Priority
Agency Recommendation Status
Veterans Health Administration
Priority Rec.
This is a priority 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)
Open

VHA officials said in August 2021 they continued to disagree with the recommendation and, as of February 2022, has not taken any action. Although VA responded to our report by stating that the ability to count physicians does not affect its ability to assess workload, we maintain that an accurate count of all physicians providing care at each medical center is necessary for accurate workforce planning. To implement the first recommendation, VHA needs to develop a system-wide process to collect information on all physicians providing care at VAMCs, including physicians that are not employed by

Veterans Health Administration The Undersecretary for Health should establish a system-wide method to share information about physician trainees to help fill vacancies across VAMCs. (Recommendation 4)
Open

VHA concurred with this recommendation. As of August 2021, VA continues to work to enable a system-wide method for sharing information about physician trainees. VA has made changes to their internal personnel system - HR Smart - and piloted the system. As a result of the pilot, VA is in the process of selecting a secure, online registration system for the health professions trainee registration and tracking. According to VA, having a registration system that allows health professional trainees, including physician trainees, to enter their own data is critical to the system's success. Once

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For questions about a specific recommendation, contact the person or office listed with the recommendation. For general information about recommendations, contact GAO's Audit Policy and Quality Assurance office at (202) 512-6100 or apqa@gao.gov.