  The American Veteran's #1 Information Source Click here to make VA Watchdog dot Org your homepage VA NEWS FLASH from Larry Scott at VA Watchdog dot Org -- 03-14-2009 |
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The American Veteran's #1 Information Source Click here to make VA Watchdog dot Org your homepage VA NEWS FLASH from Larry Scott at VA Watchdog dot Org -- 03-14-2009 |
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IN TWO KEY AREAS -- "Challenges" is code for major problems in healthcare budgeting and sharing records with DoD.
We will post the Highlights of two GAO testimonies before Congress. Both of these issues have been going on for years, and there just doesn't appear to be any end in sight. First on VA healthcare budgeting... then on VA / DoD record sharing. If you would like to read the full reports, links
are on our GAO Reports Page, here... Your comments accepted at bottom of page.
Testimony: Before the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, Committee on Appropriations, House of Representatives: United States Government Accountability Office: GAO: For Release on Delivery: Expected at 10:00 a.m. EDT: Thursday, March 12, 2009: VA Health Care: Challenges in Budget Formulation and Execution: Statement of Randall B. Williamson: Director, Health Care: GAO-09-459T: GAO Highlights: Highlights of GAO-09-459T, a testimony before the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, Committee on Appropriations, House of Representatives. Why GAO Did This Study: 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 [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-958 ] (Sept. 2006); VA Heath Care: Spending for Mental Health Strategic Plan Initiatives Was Substantially Less Than Planned [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-66 ] (Nov. 2006 ); and VA Health Care: Long-Term Care Strategic Planning and Budgeting Need Improvement [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-09-145 ] (Jan. 2009). What GAO Found: VA faces challenges formulating its health care budget each fiscal year. As noted in GAO’s 2006 report on VA’s overall health care budget, these include making realistic assumptions about the budgetary impact of policy changes, making accurate calculations, and obtaining sufficient data for useful budget projections. For example, GAO found that VA made unrealistic assumptions about how quickly it would realize savings from proposed changes in nursing home policy. While VA took steps to respond to GAO’s 2006 recommendations about VA budgeting, recent GAO work found similar issues. In 2009, GAO reported on VA’s long-term care budget—namely, on challenges in projecting the amount and cost of VA long-term care. GAO found that in its fiscal year 2009 budget justification, VA used assumptions about the cost of nursing home and noninstitutional care that appeared unrealistically low given recent VA experience and other indicators. VA said it would complete an action plan responding to GAO’s 2009 recommendations by the end of March 2009. VA also faces challenges executing its health care budget. These include spending and tracking funds for specific initiatives and providing timely and useful information to Congress on budget execution progress and problems. GAO’s 2006 report on VA funding for new mental health initiatives found VA had difficulty spending and tracking funds for initiatives in VA’s mental health strategic plan to expand services to address service gaps. The initiatives were to enhance VA’s larger mental health program and were to be funded by $100 million in fiscal year 2005. Some VA medical centers did not spend all the funds they had received for the initiatives by the end of the fiscal year, partly due to the time it took to hire staff and renovate space for mental health programs. Also, VA did not track how funding allocated for the initiatives was spent. GAO’s 2006 report on VA’s overall health care budget found that VA monitored its health care budget execution and identified execution problems for fiscal years 2005 and 2006, but did not report the problems to Congress in a timely way. GAO also found that VA’s reporting on budget execution to Congress could have been more informative. VA has not fully implemented one of GAO’s two recommendations for improving VA budget execution. Sound budget formulation, monitoring of budget execution, and the reporting of informative and timely information to Congress for oversight continue to be essential as VA addresses budget challenges GAO has identified. Budgeting involves imperfect information and uncertainty, but VA has the opportunity to improve the credibility of its budgeting by continuing to address identified problems. This is particularly true for long-term care, where for several years GAO work has highlighted concerns about workload assumptions and cost projections. By improving its budget process, VA can increase the credibility and usefulness of information it provides to Congress on its budget plans and progress in spending funds. GAO’s prior work on new mental health initiatives may provide a cautionary lesson about expanding VA programs—namely, that funding availability does not always mean that new initiatives will be fully implemented in a given fiscal year or that funds will be adequately tracked.
United States Government Accountability Office: GAO: For Release on Delivery: Expected at 10:00 a.m. EDT: Thursday, March 12, 2009: Information Technology: Challenges Remain for VA’s Sharing of Electronic Health Records with DOD: Statement of Valerie C. Melvin, Director: Information Management and Human Capital Issues: GAO-09-427T: GAO Highlights: Highlights of GAO-09-427T, a testimony before the Subcommittee on Military Construction, Veterans' Affairs, and Related Agencies; House Committee on Appropriations. Why GAO Did This Study: For over a decade, the Department of Veterans Affairs (VA) and the Department of Defense (DOD) have been engaged in efforts to improve their ability to share electronic health information. These efforts are vital for making patient information readily available to health care providers in both departments, reducing medical errors, and streamlining administrative functions. In addition, Congress has mandated that VA and DOD jointly develop and implement, by September 30, 2009, electronic health record systems or capabilities that are fully interoperable and compliant with applicable federal interoperability standards. (Interoperability is the ability of two or more systems or components to exchange information and to use the information that has been exchanged.) The experience of VA and DOD in this area is also relevant to broader efforts to advance the nationwide use of health information technology (IT) in both the public and private health care sectors—a goal of both current and past administrations. In this statement, GAO describes VA’s and DOD’s achievements and challenges in developing interoperable electronic health records, including brief comments on how these apply to the broader national health IT effort. What GAO Found: Through their long-running electronic health information sharing initiatives, VA and DOD have succeeded in increasing their ability to share and use health information. In particular, they are sharing certain clinical information (pharmacy and drug allergy data) in computable form—that is, in a format that a computer can understand and act on. This permits health information systems to provide alerts to clinicians on drug allergies, an important feature that was given priority by the departments’ clinicians. The departments are now exchanging this type of data on over 27,000 shared patients—an increase of about 9,000 patients between June 2008 and January 2009. Sharing computable data is considered the highest level of interoperability, but other levels also have value. That is, data that are only viewable still provide important information to clinicians, and much of the departments’ shared information is of this type. However, the departments have more to do: not all electronic health information is yet shared, and although VA’s health data are all captured electronically, information is still captured on paper at many DOD medical facilities. To share and use health data has required, among other things, that VA and DOD agree on standards. At the same time, they are participating in federal standards-related initiatives, which is important both because of the experience that the departments bring to the national effort, and also because their involvement helps ensure that their adopted standards are compliant with federal standards. However, these federal standards are still emerging, which could complicate the departments’ efforts to maintain compliance. Finally, the departments’ efforts face management challenges. Specifically, the effectiveness of the departments’ planning for meeting the deadline for fully interoperable electronic health records is reduced because their plans did not consistently identify results- oriented performance goals (i.e., goals that are objective, quantifiable, and measurable) or measures that would permit progress toward the goals to be assessed. Further constraining VA’s and DOD’s planning effectiveness is their inability to complete all necessary activities to set up the interagency program office, which is intended to be accountable for fulfilling the departments’ interoperability plans. Defining goals and ensuring that these are met would be an important part of the task of the program office. Without a fully established office that can manage the effort to meet these goals, the departments increase the risk that they will not be able to share interoperable electronic health information to the extent and in the manner that most effectively serves military service members and veterans. Accordingly, GAO has recommended that the departments give priority to fully establishing the interagency program office and develop results-oriented performance goals and measures to be used as the basis for reporting interoperability progress. The departments concurred with these recommendations. -------------------------
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