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Veterans Health Administration: Community- Based Outpatient Clinics

Description: This report provides an overview of Department of Veterans Affairs (VA) rationale in establishing Community-Based Outpatient Clinics (CBOCs), describes how they are managed and administered, discusses medical services provided at CBOCs, and summarizes what is known about the quality and cost of providing care in CBOCs compared to primary care clinics at VA Medical Centers. Lastly, it describes the process for developing a new CBOC.
Date: January 28, 2010
Creator: Viranga Panangala, Sidath
Partner: UNT Libraries Government Documents Department

Veterans Affairs: Health Care and Benefits for Veterans Exposed to Agent Orange

Description: This report provides an overview of health care services and disability compensation benefits available to Vietnam veterans, Children of Vietnam Era veterans, and non-Vietnam veterans exposed to herbicides. This is followed by a discussion of the recent litigation pertaining to Navy veterans of the Vietnam Era who served offshore and were never physically present on Vietnamese soil.
Date: October 30, 2009
Creator: Panangala, Sidath V. & Weimer, Douglas R.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: Improvements Needed to Ensure That Budget Estimates Are Reliable and That Spending for Facility Maintenance Is Consistent with Priorities

Description: A letter report issued by the Government Accountability Office with an abstract that begins "During fiscal years 2006 through 2012, the Department of Veterans Affairs (VA) had higher than estimated resources available for facility maintenance and improvement--referred to as non-recurring maintenance (NRM); these resources accounted for the $4.9 billion in VA's NRM spending that exceeded budget estimates. The additional resources came from two sources. First, VA spent less than it estimated on non-NRM, facility-related activities such as administrative functions, utilities, and rent, which allowed VA to spend over $2.5 billion more than originally estimated. Lower spending for administrative functions, utilities, and rent accounted for most of the resources estimated but not spent on non-NRM activities. Given that VA has consistently overestimated the costs of such activities in recent years, VA's budget estimates for its non-NRM activities may not be reliable. Second, more than $2.3 billion of the higher than estimated spending on NRM can be attributed to VA having higher than estimated budget resources available. In some years VA received higher appropriations from Congress than requested and supplemental appropriations for NRM--such as those included in the American Recovery and Reinvestment Act of 2009. The additional budget resources VA used for NRM also included transfers of funds from the agency's appropriations account that funds health care services."
Date: February 22, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: Oversight of Tissue Product Safety

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Data from the Veteran's Health Administration (VHA), within the Department of Veterans Affairs (VA), do not show evidence of VHA receiving contaminated tissue products, although, it is difficult to link adverse events in recipients to such products. VA's National Center for Patient Safety (NCPS), which began operation in 1999, has not issued any patient safety alerts—mandates for action to address actual or potential threats to life or health—or advisories—guidance to address issues such as equipment design and product failure—related to tissue products potentially received by VA medical centers (VAMC) in the last 10 years. NCPS issues patient safety alerts and advisories for recalls that require specific clinical actions to ensure patient safety. Since NCPS began issuing and recording data on recalls in November 2008, NCPS has notified VAMCs of 13 recalls for tissue products from vendors from which VHA could have received affected products—none of these recalls have resulted in patient safety alerts or advisories. For 6 of the recalls, 27 VAMCs reported to NCPS that they had identified and removed the recalled products from their inventories. For the other 7 recalls, none of the VAMCs had the affected tissue products in their inventories. The 13 recalls were not issued for known tissue product contamination. Instead, most were initiated because of the possibility of contamination, such as compromise of product sterility and incomplete donor records. Further, VHA officials told us that their analysis of VHA data found no evidence of reported adverse events among VHA patients that were caused by contaminated tissue products. According to officials from the Food and Drug Administration (FDA), post-surgical infections often occur, even in the absence of tissue use, and it is often not possible to definitively attribute such infections to a tissue ...
Date: April 2, 2014
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans Health Care: VA's Medical Support Role in Emergency Preparedness

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Since the terrorist attacks on September 11, 2001, the Department of Veterans Affairs (VA) has increased its efforts to plan for and respond to national emergencies, including acts of terrorism and natural disasters. Additionally, in August 2004, the Federal Bureau of Investigation and the Department of Homeland Security announced that military and VA medical facilities were potential terrorist targets. In light of military casualties from conflicts in Afghanistan and Iraq and continued threats of terrorist incidents, Congress asked us to review VA's medical support role in emergency preparedness. Specifically, we agreed to provide information on the following questions: (1) What is VA's role in providing medical support within the U.S. to military personnel in wartime and during national emergencies? (2) What actions has VA taken to improve its internal emergency preparedness to ensure that it is ready to maintain continuity of operations and provision of medical services to veterans? (3) What is VA's role in participating in emergency medical response measures with other federal, state, and local agencies?"
Date: March 23, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: Observations on VA's Assessment of Hepatitis C Budgeting and Funding

Description: A statement of record issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) requested and received $195 million for Hepatitis C screening and treatment in fiscal year 2000. VA's budget documentation showed that it had spent $100 million on Hepatitis C screening and treatment, leaving a difference of $95 million between its estimated and actual expenditures. However, GAO's review revealed that the difference was actually much larger--$145 million. VA's documentation showed that only $50 million was used for budgeted activities and $50 million was used for an activity not included in its original budget--treatment of conditions related to Hepatitis C. It appears that VA is unable to develop a budget estimate that can reliably forecast its Hepatitis C funding needs at this time. However, VA's Veterans Health Administration (VHA) appears to be taking reasonable steps to improve future budget estimates and thereby minimize the potential for large differences. Such steps include developing a Hepatitis C patient registry that could provide the critical data needed to improve budgetary estimates. However, this registry could take as long as 15 months to become operational, which suggests that it may not provide budgetary data in time to formulate the 2004 budget. In the meantime, VHA's ongoing efforts to upgrade its data collection systems should help improve budget estimates for fiscal year 2002. These efforts, however, have provided only minimal help in the development of VA's 2002 budget for Hepatitis C spending. As a result, it is not possible to conclude with certainty whether VA's fiscal year 2002 spending estimate of $171 million is appropriate."
Date: April 25, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care Budget: Transparency and Reliability of Some Estimates Supporting President's Request Could Be Improved

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The President’s fiscal year 2013 budget request for the Department of Veterans Affairs’ (VA) health care services was $165 million more than the earlier advance appropriations request for the same year. This request reflected a $2 billion increase for initiatives and a $2.1 billion decrease for ongoing health care services, for a net decrease of $110 million in expected obligations. This decrease partially offset a decline in anticipated resources available to VA of $275 million, resulting in the net increase in the President’s request of $165 million. Two of the three factors that accounted for most of these changes were not transparent. First, VA used a new reporting approach for initiatives that combined both funding for initiatives and for certain ongoing health care services in its initiatives estimate. Previously, VA had reported only funding it identified for initiatives during that year. This new reporting approach resulted in an increase in VA’s initiatives estimate and a commensurate decrease in VA’s ongoing services estimate. VA officials told GAO that this change was made to be more transparent about the total funding needed for initiatives. However, because VA did not disclose this change in its budget justification, VA has not made it transparent that its initiatives estimate is greater and its ongoing health care services estimate is lower than they would have been using VA’s past approach. Second, VA included additional funding in its initiatives estimate, in part, to fund initiatives that were not identified in the fiscal year 2013 advance appropriations request. VA also did not make transparent in its budget justifications that some initiatives identified in its fiscal years 2013 and 2014 advance appropriations requests may require additional funding if the initiatives are continued. The lack of ...
Date: June 11, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care Budget: Improvements Made, but Additional Actions Needed to Address Problems Related to Estimates Supporting President's Request

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) expanded the use of the Enrollee Health Care Projection Model (EHCPM) in developing the agency’s health care budget estimate that supported the President’s fiscal year 2014 budget request. VA expanded the use of the EHCPM by using, for the first time, the model’s estimate for the amount of care provided—workload—to develop estimates of the resources needed for 14 long-term care services. However, VA continued to use the most current expenditure data rather than EHCPM estimates for projecting needed resources for these services due to concerns about the reliability of the EHCPM expenditure data. Using this new blended approach, VA used the EHCPM in whole or in part, to develop estimates for 74 health care services that accounted for more than 85 percent of VA’s health care budget estimate. Additionally, VA used a new budget category label for its estimate of certain administrative personnel costs, “Administrative Personnel,” and identified the types of positions this estimate included. However, VA did not consistently use the new label across its three health care appropriations accounts. Instead, VA used “Administration” and provided no information clarifying the costs included in the estimates. Further, VA did not disclose all the costs included under “Administrative Personnel,” nor did VA identify the costs included in one other category containing administrative costs, “Administrative Contract Services.” The lack of transparency regarding administrative costs and inconsistent labeling resulted in Congress and other users of VA’s budget justification not having clear and complete information regarding the agency’s estimates for such costs."
Date: August 8, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans Affairs: Health Care and Benefits for Veterans Exposed to Agent Orange

Description: This report provides an overview of health care services and disability compensation benefits available to Vietnam veterans, Children of Vietnam Era veterans, and non-Vietnam veterans exposed to herbicides. This is followed by a discussion of litigation pertaining to Navy veterans of the Vietnam Era who served offshore and were never physically present on Vietnamese soil. The report concludes with a discussion of epidemiologic research conducted to study the health effects of Agent Orange and dioxin exposure on Vietnam veterans.
Date: September 22, 2010
Creator: Panangala, Sidath Viranga & Weimer, Douglas Reid
Partner: UNT Libraries Government Documents Department

Veterans Health Care: Veterans Health Administration Processes for Responding to Reported Adverse Events

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Through its policy and guidance, VHA has outlined processes that enable VAMCs to respond to reported adverse events that occur. VHA generally grants individual VAMCs discretion on choosing which process to use. Specifically, VAMCs conduct an initial review to determine how best to respond to an adverse event. According to VHA officials, if the circumstances that led to an adverse event are clear, based on a VAMC's initial review, VAMCs can take immediate corrective action. If the circumstances that led to an adverse event need to be examined further, VAMCs are given discretion to use one or more of the following four processes: (1) root cause analysis, (2) peer review, (3) clinical care review, and (4) administrative investigation board. Because VAMCs generally have discretion in which of these processes they use, different VAMCs that experience similar adverse events may not use the same processes to respond to them. Nonetheless, each process has certain purposes and limitations. For example, some of these processes may be used to examine a clinician's actions as they relate to an adverse event, while others may be used to examine whether a systems or process issue exists. Furthermore, information collected through two of these processes--clinical care reviews and administrative investigation boards--can be used to inform actions against clinicians; information collected using root cause analyses and peer reviews cannot be used to support such actions, because information collected under those processes is protected and confidential, under federal law. Based on the nature of an adverse event and the information gleaned through a particular review process, a VAMC may decide to conduct multiple types of reviews, as appropriate."
Date: August 24, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: Fiscal Year 2000 Budget

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the Veterans Health Administration's (VHA) plans to spend an additional $900 million requested for veterans' medical care and the likelihood of VHA's achieving its proposed management efficiency savings."
Date: September 14, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care Budget: Better Labeling of Services and More Detailed Information Could Improve the Congressional Budget Justification

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) creates its budget request through its Enrollee Health Care Projection Model (EHCPM) using data from systems designed for the former single-account structure. These systems do not explicitly consider the three appropriations accounts: Medical Services, Medical Support and Compliance, and Medical Facilities. According to Veterans Health Administration (VHA) officials, VHA formulates its budget based on the single appropriations account, in part, because the systems to formulate the request were in place prior to 2004, which was when the three-account structure was established. VA then presents the information in the Congressional Budget Justification (CBJ) by taking the data developed by the EHCPM and then, based on historical percentages and future projections, assigning the requested amounts to the three appropriations accounts."
Date: September 18, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care Budget Estimate: Changes Were Made in Developing the President's Budget Request for Fiscal Years 2012 and 2013

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Veterans Health Care Budget Reform and Transparency Act of 2009 requires GAO to report whether the amounts for the Department of Veterans Affairs' (VA) health care services in the President's budget request are consistent with VA's budget estimates as projected by the Enrollee Health Care Projection Model (EHCPM) and other methodologies. Based on the information VA provided, this report describes (1) the key changes VA identified that were made to its budget estimate to develop the President's budget request for fiscal years 2012 and 2013 and (2) how various sources of funding for VA health care and other factors informed the President's budget request for fiscal years 2012 and 2013. GAO reviewed documents describing VA's estimates projected by the EHCPM and changes made to VA's budget estimate that affect all services, including estimates developed using other methodologies. GAO also reviewed the President's budget request, VA's congressional budget justification, and interviewed VA officials and staff from the Office of Management and Budget (OMB)."
Date: June 14, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: VA Uses a Projection Model to Develop Most of Its Health Care Budget Estimate to Inform the President's Budget Request

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Funding for the Department of Veterans Affairs' (VA) health care is determined by Congress in the annual appropriations process. Prior to this process, VA develops a budget estimate of the resources needed to provide health care services to eligible veterans. The Veterans Health Care Budget Reform and Transparency Act of 2009 requires GAO to assess whether the funding requested for VA health care in the President's budget requests submitted to Congress in 2011, 2012, and 2013 is consistent with VA's estimates of the resources needed to provide health care services. In anticipation of these future studies, GAO was asked to obtain information on how VA prepares its health care budget estimate. In this report, GAO describes (1) how VA develops its health care budget estimate, and (2) how VA's health care budget estimate is used in the President's budget request to Congress. To conduct this work, GAO reviewed VA documents on the methods, data, and assumptions used to develop VA's health care budget estimate that informed the President's budget request for fiscal year 2011 and request for advance appropriations for fiscal year 2012. GAO also interviewed VA officials responsible for developing this estimate and staff from the Office of Management and Budget (OMB), which is responsible for overseeing the development and implementation of the federal budget."
Date: January 31, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans Affairs: Health Care and Benefits for Veterans Exposed to Agent Orange

Description: This report provides an overview of health care services and disability compensation benefits available to Vietnam veterans, Children of Vietnam Era veterans, and non-Vietnam veterans exposed to herbicides. This is followed by a discussion of litigation pertaining to Navy veterans of the Vietnam Era who served offshore and were never physically present on Vietnamese soil. The report concludes with a discussion of epidemiologic research conducted to study the health effects of Agent Orange and dioxin exposure on Vietnam veterans.
Date: August 25, 2008
Creator: Panangala, Sidath Viranga & Weimer, Douglas Reid
Partner: UNT Libraries Government Documents Department

Veterans Health Care: Monitoring Is Needed to Determine the Accuracy of Veteran Copayment Charges

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2010, the Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) billed veterans millions of medical copayment charges totaling more than $1 billon. Witnesses at a 2009 Subcommittee on Health, House Committee on Veterans' Affairs, hearing raised concerns about inappropriate copayment charges, including some associated with veterans' service-connected conditions. As a result, members of the Subcommittee asked GAO to review (1) VHA copayment charge accuracy, including error rates and related causes, and (2) VHA efforts to monitor copayment charge accuracy. To assess the accuracy of VHA's billed copayment charges, GAO evaluated samples of fiscal year 2010 billed and unbilled medical services to determine copayment error rates and related causes. GAO also reviewed VHA practices related to monitoring the accuracy of copayment charges.."
Date: August 29, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: VA Needs Better Data on Extent and Causes of Waiting Times

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) efforts to reduce the waiting times for outpatient care, focusing on VA's initiatives to: (1) improve its waiting time; and (2) address its waiting time problems."
Date: May 31, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: Standards and Accountability Could Improve Hepatitis C Screening and Testing Performance

Description: Testimony issued by the General Accounting Office with an abstract that begins "Three years ago, the Department of Veterans Affairs (VA) characterized hepatitis C as a serious national health problem that needs early detection to reduce transmission risks, ensure timely treatment, and prevent progression of liver disease. In a 1988 letter, VA outlined the process clinicians should use when (1) screening veterans for known risk factors for exposure to hepatitis C and (2) ordering tests to detect antibodies and diagnose hepatitis C infection as part of a plan to evaluate and assess risk factors for VA patients. This testimony discusses VA's progress in screening and testing veterans for hepatitis C during fiscal years 1999 and 2000. GAO found that VA missed opportunities to screen as many as three million veterans when they visited medical facilities during fiscal years 1999 and 2000, potentially leaving as many as 200,000 veterans unaware that they have hepatitis C infections. Of those screened, an unknown number likely remain undiagnosed because of flawed procedures. Although the pace of screening and testing appears to be improving, many currently undiagnosed veterans may not be identified expeditiously unless VA (1) establishes early detection of hepatitis C as a standard for care and (2) holds facility managers accountable for timely screening and testing of veterans who visit VA medical facilities."
Date: June 14, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department