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VA Health Care: Preliminary Findings on VA's Provision of Health Care Services to Women Veterans

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Historically, the vast majority of VA patients have been men, but that is changing. VA provided health care to over 281,000 women veterans in 2008--an increase of about 12 percent since 2006--and the number of women veterans in the United States is projected to increase by 17 percent between 2008 and 2033. Women veterans seeking care at VA medical facilities need access to a full range of health care services, including basic gender-specific services--such as cervical cancer screening--and specialized gender-specific services--such as treatment of reproductive cancers. This testimony, based on ongoing work, discusses GAO's preliminary findings on (1) the on-site availability of health care services for women veterans at VA facilities, (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care services for women veterans, and (3) key challenges that VA facilities are experiencing in providing health care services for women veterans. GAO reviewed applicable VA policies, interviewed officials, and visited 19 medical facilities--9 VA medical centers (VAMC) and 10 community-based outpatient clinics (CBOC)--and 8 Vet Centers. These facilities were chosen based in part on the number of women using services and whether facilities offered specific programs for women. The results from these site visits cannot be generalized to all VA facilities. GAO shared this statement with VA officials, and they generally agreed with the information presented."
Date: July 14, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Patient Safety Could be Enhanced by Improvements in Employment Screening and Physician Privileging Practices

Description: Testimony issued by the Government Accountability Office with an abstract that begins "In its March 2004 report, "VA Health Care: Improved Screening of Practitioners Would Reduce Risk to Veterans," GAO-04-566, GAO made recommendations to improve VA's employment screening of practitioners. GAO was asked to testify today on steps VA has taken to improve its employment screening requirements and VA's physician credentialing and privileging processes because of their importance to patient safety. This testimony is based on two GAO reports released today that determined the extent to which (1) VA has taken steps to improve employment screening for practitioners by implementing GAO's 2004 recommendations, (2) VA facilities are in compliance with selected credentialing and privileging requirements for physicians, and (3) VA has internal controls to help ensure the accuracy of privileging information."
Date: June 15, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Reporting of Spending and Workload for Mental Health Services Could Be Improved

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) provides, or pays for, a range of mental health services for veterans. To effectively manage resources and ensure access to eligible veterans, VA needs complete spending and workload information for mental health services. This information is also important for congressional oversight GAO was asked to examine VA's mental health spending and workload. In this report, GAO examined for fiscal year 2009 (1) VA's spending for mental health services and (2) VA's workload for mental health services. GAO examined VA's reporting of mental health spending and workload data for fiscal year 2009 in its fiscal year 2011 congressional budget justification and whether VA reported these data in any other publicly available report. GAO analyzed additional mental health spending and workload data and interviewed VA officials."
Date: May 28, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: VA Should Better Monitor Implementation and Impact of Capital Asset Alignment Decisions

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Through its Veterans Health Administration (VHA), the Department of Veterans Affairs (VA) operates one of the largest health care systems in the country. In 1999, GAO reported that better management of VA's large inventory of aged capital assets could result in savings that could be used to enhance health care services for veterans. In response, VA initiated a process known as Capital Asset Realignment for Enhanced Services (CARES). Through CARES, VA sought to enhance veteran care by the appropriate sizing, upgrading, and locating of VA facilities. GAO was asked to examine the CARES process. Specifically, GAO examined (1) how CARES contributes to VHA's capital planning process, (2) the extent to which the CARES process considered capital asset alignment alternatives, and (3) the extent to which VA has implemented CARES decisions and how this implementation has helped VA carry out its mission. To address these issues, we analyzed CARES documents, interviewed VA officials, and conducted six site visits, among other things."
Date: March 21, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Laundry Service Operations and Costs

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the Department of Veteran Affairs' (VA) laundry support services, focusing on: (1) the type and volume of laundry service VA provides; (2) how VA provides laundry services; (3) the cost VA incurs; and (4) the revenue VA generates from selling laundry services."
Date: December 21, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Continuing Oversight Needed to Achieve Formulary Goals

Description: Testimony issued by the General Accounting Office with an abstract that begins "Although the Department of Veterans Affairs (VA) has made significant progress establishing a national formulary that has generally met with acceptance by prescribers and patients, VA oversight has not fully ensured standardization of its drug benefit nationwide. The three medical centers GAO visited did not comply with the national formulary. Specifically, two of the three medical centers omitted more than 140 required national formulary drugs, and all three facilities inappropriately modified the national formulary list of required drugs for certain drug classes by adding or omitting some drugs. In addition, as VA policy allows, Veterans Integrated Service Networks (VISN) added drugs to supplement the national formulary ranging from five drugs at one VISN to 63 drugs at another. However, VA lacked criteria for determining the appropriateness of the actions networks took to add these drugs. In addition to problems standardizing the national formulary, GAO identified weaknesses in the nonformulary approval process. Although the national formulary directive requires certain criteria for approving nonformulary drugs, it does not prescribe a specific nonformulary approval process. As a result, the processes health care providers must follow to obtain nonformulary drugs differ among VA facilities on how requests are made, who receives them, who approves them, and how long it takes to obtain approval. GAO found that the length of time to approve nonformulary drugs averages nine days, but it can be as short as a few minutes in some medical centers. Some VISNs have not established processes to collect and analyze data on nonformulary requests. As a result, VA does not know if approved requests meet its established criteria or if denied requests are appropriate. This testimony summarizes the December 1999 report, HEHS-00-34 and the January 2001 report, GAO-01-183."
Date: July 24, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Preliminary Findings on VA's Provision of Health Care Services to Women Veterans

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Historically, the vast majority of VA patients have been men, but that is changing. VA provided health care to over 281,000 women veterans in 2008--an increase of about 12 percent since 2006--and the number of women veterans in the United States is projected to increase by 17 percent between 2008 and 2033. Women veterans seeking care at VA medical facilities need access to a full range of health care services, including basic gender-specific services--such as cervical cancer screening--and specialized gender-specific services--such as treatment of reproductive cancers. This testimony, based on ongoing work, discusses GAO's preliminary findings on (1) the on-site availability of health care services for women veterans at VA facilities, (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care services for women veterans, and (3) some key challenges that VA facilities are experiencing in providing health care services for women veterans. GAO reviewed applicable VA policies, interviewed officials, and visited 19 medical facilities--9 VA medical centers (VAMC) and 10 community-based outpatient clinics (CBOC)--and 10 Vet Centers. These facilities were chosen based in part on the number of women using services and whether facilities offered specific programs for women. The results from these site visits cannot be generalized to all VA facilities. GAO shared this statement with VA officials, and they generally agreed with the information presented."
Date: July 16, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Overview of VA's Capital Asset Management

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Through its Veterans Health Administration (VHA), the Department of Veterans Affairs (VA) operates one of the largest integrated health care systems in the country. In 1999, GAO reported that better management of VA's large inventory of aged capital assets could result in savings that could be used to enhance health care services for veterans. In response, VA initiated a process known as Capital Asset Realignment for Enhanced Services (CARES). Through CARES, VA sought to determine the future resources needed to provide health care to our nation's veterans. This testimony describes (1) how CARES contributes to VHA's capital planning process, (2) the extent to which VA has implemented CARES decisions, and (3) the types of legal authorities that VA has to manage its real property and the extent to which VA has used these authorities. The testimony is based on GAO's body of work on VA's management of its capital assets, including GAO's 2007 report on VA's implementation of CARES (GAO-07-408)."
Date: June 9, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Improved Planning Needed for Management of Excess Real Property

Description: A letter report issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) has changed from a hospital-based system to primary reliance on outpatient care. As a result, VA expects that the number of unneeded buildings will increase. Veterans' needs could be better served if VA finds ways to minimize resources devoted to these buildings. VA must have an effective process to find alternate uses or dispose of unneeded property. In August 2002, VA completed a pilot test for realigning its health care system in the Great Lakes network. The pilot identified 30 buildings that are no longer needed to provide health care to veterans. VA is currently studying how to realign assets in its 20 remaining networks. GAO was asked to review VA's management of unneeded buildings in its Great Lakes network."
Date: January 29, 2003
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Third-Party Charges Based on Sound Methodology; Implementation Challenges Remain

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO provided information on the Department of Veterans Affairs' (VA) third party charges, focusing on: (1) the soundness of VA's methodology for setting reasonable charges for inpatient facility, skilled nursing, outpatient facility, physician, and nonphysician services; and (2) potential effects of the new charge-based system on VA, insurers, and veterans."
Date: June 11, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Challenges in Budget Formulation and Execution

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) estimates it will provide health care to 5.8 million patients with appropriations of $41.2 billion in fiscal year 2009. The President has proposed an increase in VA's health care budget for fiscal year 2010 to expand services for veterans. VA's patient population includes aging veterans who need services such as long-term care-- including nursing home and noninstitutional care provided in veterans' homes or community-- and veterans returning from Afghanistan and Iraq. Each year, VA formulates its medical care budget, which involves developing estimates of spending for VA's health care services. VA is also responsible for budget execution-- spending appropriations and monitoring their use. GAO was asked to discuss challenges related to VA's health care services budget formulation and execution. This statement focuses on (1) challenges VA faces in formulating its health care budget, and (2) challenges VA faces in executing its health care budget. This testimony is based on three GAO reports: VA Health Care: Budget Formulation and Reporting on Budget Execution Need Improvement (GAO-06-958) (Sept. 2006); VA Heath Care: Spending for Mental Health Strategic Plan Initiatives Was Substantially Less Than Planned (GAO-07-66) (Nov. 2006); and VA Health Care: Long-Term Care Strategic Planning and Budgeting Need Improvement (GAO-09-145) (Jan. 2009)."
Date: March 12, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Improvements Needed for Monitoring and Preventing Sexual Assaults and Other Safety Incidents

Description: Testimony issued by the Government Accountability Office with an abstract that begins "During GAO's recent work on services available for women veterans (GAO-10-287), several clinicians expressed concern about the physical safety of women housed in mental health programs at a Department of Veterans Affairs (VA) medical facility. GAO examined (1) the volume of sexual assault incidents reported in recent years and the extent to which these incidents are fully reported, (2) what factors may contribute to any observed underreporting, and (3) precautions VA facilities take to prevent sexual assaults and other safety incidents. This testimony is based on recent GAO work, "VA Health Care: Actions Needed To Prevent Sexual Assaults and Other Safety Incidents," (GAO-11-530) (June 2011). For that report, GAO reviewed relevant laws, VA policies, and sexual assault incident documentation from January 2007 through July 2010. In addition, GAO visited five judgmentally selected VA medical facilities that varied in size and complexity and spoke with the four Veterans Integrated Service Networks (VISN) that oversee them."
Date: June 13, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Allocation Changes Would Better Align Resources with Workload

Description: A letter report issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) spent $21 billion in fiscal year 2001 to treat 3.8 million veterans--most of whom had service-connected disabilities or low incomes. Since 1997, VA has used the Veterans Equitable Resource Allocation (VERA) system to allocate most of its medical care appropriation. GAO found that VERA has had a substantial impact on network resource allocations and workloads. First, VERA shifted $921 million from networks located primarily in the northeast and midwest to networks located in the south and west in fiscal year 2001. In addition, VERA, along with other VA initiatives, has provided an incentive for networks to serve more veterans. VERA's overall design is a reasonable approach to allocate resources commensurate with workloads. It provides a predetermined dollar amount per veteran served to each of VA's 22 health care networks. This amount varies depending upon the health care needs of the veteran served and local cost differences. This approach is designed to allocate resources commensurate with each network's workload in terms of veterans served and their health care needs. GAO identified weaknesses in VERA's implementation. First, VERA excludes about one fifth of VA's workload in determining each network's allocation. Second, VERA does not account well for cost differences among networks resulting from variation in their patients' health care needs. Third, the process for providing supplemental resources to networks through VA's National Reserve Fund has not been used to analyze how the need for such resources is caused by potential problems in VERA's allocation, network inefficiency, or other factors."
Date: February 28, 2002
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Weaknesses in Policies and Oversight Governing Medical Equipment Pose Risks to Veterans' Safety

Description: Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses patient safety incidents at Department of Veterans Affairs (VA) medical centers and potential strategies to address the underlying causes of those incidents. VA operates one of the largest integrated health care delivery systems in the United States, providing care to over 5.5 million veterans annually. Organized into 21 Veterans Integrated Service Networks (VISN), VA's health care system includes 153 VA medical centers (VAMC) nationwide that offer a variety of outpatient, residential, and inpatient services. In providing health care services to veterans, clinicians at VAMCs use reusable medical equipment (RME), which is designed to be reused for multiple patients and includes such equipment as endoscopes and some surgical and dental instruments. Because RME is used when providing care to multiple veterans, this equipment must be reprocessed--that is, cleaned and disinfected or sterilized--between uses. VA has established requirements for VAMCs to follow when reprocessing RME, which are designed, in part, to help ensure the safety of the veterans who receive care at VAMCs. This testimony, based on our May 2011 report, which is being released today, examines issues related to veterans' safety, including (1) selected reprocessing requirements established in VA policies, based on their relevance to patient safety incidents and (2) VA's oversight of VAMCs' compliance with these selected requirements."
Date: May 3, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Supply of Nursing Home Beds Is Sufficient to 2005 in the Detroit, Michigan, Area

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) needs assessment of nursing home care in Detroit, Michigan."
Date: August 21, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Adequacy of Resident Supervision Is Not Assured, but Plans Could Improve Oversight

Description: A letter report issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) provides graduate medical education (GME) to as many as one-third of U.S. resident physicians, but oversight responsibilities spread across VA's organizational components and multiple affiliated hospitals and medical schools could allow supervision problems to go undetected or uncorrected. GAO was asked to examine VA's procedures for (1) monitoring VA medical centers' adherence to VA's requirements for resident supervision, (2) using evaluations of supervision by GME accrediting bodies and residents, and (3) using information about resident supervision drawn from VA's programs for monitoring the quality and outcomes of patient care."
Date: July 2, 2003
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

DOD and VA Health Care: Challenges Encountered by Injured Servicemembers during Their Recovery Process

Description: Testimony issued by the Government Accountability Office with an abstract that begins "As of March 1, 2007, over 24,000 servicemembers have been wounded in action since the onset of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), according to the Department of Defense (DOD). GAO work has shown that servicemembers injured in combat face an array of significant medical and financial challenges as they begin their recovery process in the health care systems of DOD and the Department of Veterans Affairs (VA). GAO was asked to discuss concerns regarding DOD and VA efforts to provide medical care and rehabilitative services for servicemembers who have been injured during OEF and OIF. This testimony addresses (1) the transition of care for seriously injured servicemembers who are transferred between DOD and VA medical facilities, (2) DOD's and VA's efforts to provide early intervention for rehabilitation for seriously injured servicemembers, (3) DOD's efforts to screen servicemembers at risk for post-traumatic stress disorder (PTSD) and whether VA can meet the demand for PTSD services, and (4) the impact of problems related to military pay on injured servicemembers and their families. This testimony is based on GAO work issued from 2004 through 2006 on the conditions facing OEF/OIF servicemembers at the time the audit work was completed."
Date: March 5, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Changes Needed to Improve Resource Allocation to Health Care Networks

Description: Testimony issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) spent $21 billion in fiscal year 2001 to treat 3.8 million veterans--most of whom had service-connected disabilities or low incomes. Since 1997, VA has used the Veterans Equitable Resource Allocation (VERA) system to allocate most of its medical care appropriation. GAO found that VERA has had a substantial impact on network resource allocations and workloads. VERA shifted $921 million from networks primarily in the northeast and midwest to networks in the south and west in fiscal year 2001. VERA, along with other VA initiatives, has provided an incentive for networks to serve more veterans. In GAO's view, VERA's overall design is a reasonable approach to allocating resources according to workloads. It provides a predetermined dollar amount per veteran served to each of VA's 22 health care networks. This amount varies depending upon the health care needs of the veteran served and local cost differences. However, GAO identified weaknesses in VERA's implementation. First, VERA excludes about one fifth of VA's workload in determining each network's allocation. Second, VERA does not account well for cost differences among networks resulting from variation in their patients' health care needs. Third, the process for providing supplemental resources to networks through VA's National Reserve Fund has not been used to analyze how the need for such resources is caused by potential problems in VERA's allocation, network inefficiency, or other factors. This testimony is based on an April report (GAO-02-338)."
Date: May 14, 2002
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

DOD and VA Health Care: Jointly Buying and Mailing Out Pharmaceuticals Could Save Millions of Dollars

Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed what the Department of Veterans Affairs (VA) and Department of Defense (DOD) have done and what more they could do to reduce drug prices and dispensing costs, focusing on the: (1) extent of joint DOD and VA drug contracting thus far and the prospects for further contracting; (2) prospects of DOD using VA's consolidated mail outpatient pharmacy (CMOP) centers to handle its hospital outpatient pharmacy refill workload; and (3) possible need for measures to facilitate such joint actions to bring about further improvements."
Date: May 25, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: VA Has Not Sufficiently Explored Alternatives for Optimizing Third-Party Collections

Description: Testimony issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) has reversed the general decline in its third-party collections for the first time since fiscal year 1995. The fiscal year 2001 increase appears to be largely the result of VA's implementation of a new system, known as the reasonable charges billing system, which allowed VA to move from a flat-rate billing system to one that itemizes charges. However, long-standing problems in VA's revenue operations persist, and VA's collections performance is poor when compared to that of the private sector. VA's attempts at consolidation using either in-house or contractor staff have provided little basis for selecting the best alternative to VA's collections problems. Also, VA's recent 2001 Revenue Cycle Improvement Plan does not call for a comprehensive comparison of alternatives, nor does it focus on net revenues--collections minus operations costs. To collect the most funds for veterans' medical care at the lowest cost, VA needs to develop a business plan and detailed implementation approach that will provide useful data for optimizing net revenues from third-party payments."
Date: September 20, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Preliminary Information on the Joint Venture Proposal for VA's Charleston Facility

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) maintains partnerships, or affiliations, with university medical schools to obtain medical services for veterans and provide training for medical residents. In 2002, the Medical University of South Carolina (MUSC)--which is affiliated with VA's medical facility in Charleston--proposed that VA and MUSC enter into a joint venture for a new VA facility as part of MUSC's plan to expand its medical campus. Under the proposal, MUSC and VA would jointly construct and operate a new medical center in Charleston. In 2004, the Capital Asset Realignment for Enhanced Services (CARES) Commission, an independent body charged with assessing VA's capital asset requirements, issued its recommendations on the realignment and modernization of VA's capital assets. Although the Commission did not recommend a replacement facility for Charleston, it did recommend, among other things, that VA promptly evaluate MUSC's proposal. This testimony discusses GAO's preliminary findings on the (1) current condition of the Charleston facility, (2) extent to which VA and MUSC collaborated on the joint venture proposal, and (3) issues for VA to consider when exploring the opportunity to participate in the joint venture. VA concurred with GAO's preliminary findings."
Date: September 26, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Reliability of Reported Outpatient Medical Appointment Wait Times and Scheduling Oversight Need Improvement

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Outpatient medical appointment wait times reported by the Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), are unreliable. Wait times for outpatient medical appointments--referred to as medical appointments--are calculated as the number of days elapsed from the desired date, which is defined as the date on which the patient or health care provider wants the patient to be seen. The reliability of reported wait time performance measures is dependent on the consistency with which schedulers record the desired date in the scheduling system in accordance with VHA's scheduling policy. However, VHA's scheduling policy and training documents for recording desired date are unclear and do not ensure consistent use of the desired date. Some schedulers at Veterans Affairs medical centers (VAMC) that GAO visited did not record the desired date correctly. For example, three schedulers changed the desired date based on appointment availability; this would have resulted in a reported wait time that was shorter than the patient actually experienced. VHA officials acknowledged limitations of measuring wait times based on desired date, and described additional information used to monitor veterans' access to medical appointments, including patient satisfaction survey results. Without reliable measurement of how long patients are waiting for medical appointments, however, VHA is less equipped to identify areas that need improvement and mitigate problems that contribute to wait times."
Date: December 21, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Food Service Operations and Costs at Inpatient Facilities

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the Department of Veterans Affairs' (VA) food service operations, focusing on: (1) the type and volume of food services VA provides; (2) how VA provides food services; (3) the cost VA incurs; and (4) the revenues VA generates from sales of excess food services."
Date: November 19, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department