Government and Regulations

VHA Under Harsh Criticism From OIG, GAO

Due to VHA's inconsistencies and inadequacies, the U.S. Government Accountability Office and the Office of the Inspector General have placed VHA on its "High Risk List."

Publish date: May 6, 2015

References

In testimony before the U.S. Senate Committee on Veterans’ Affairs on April 29, 2015, Carolyn M. Clancy, MD, interim under secretary for health at the VHA, responded to criticism leveled by senators, the U.S. Government Accountability Office (GAO), and the Office of the Inspector General. The hearings were prompted by the GAO’s February 11, 2015, Managing Risks and Improving VA Health Care report that added the VHA to its “High Risk List” and included more than 100 recommended changes for VHA.

“The Secretary and I, along with all of our senior leadership, are strongly committed to developing long-term solutions that mitigate risk to the timeliness, cost-effectiveness, quality, and safety of the VA health care system,” Dr. Clancy reassured the committee. “VHA has the capacity to address the problems GAO clearly identified in the report. I have directed all senior leaders at VHA to identify resource needs in their areas of control to insure that our strategic plans support resolution of the GAO’s high-risk areas.”

According to the GAO, the VHA’s high-risk areas include ambiguous policies and inconsistent processes, inadequate oversight and accountability, information technology challenges, inadequate training for VA staff, and unclear resource needs and allocation priorities.

In written testimony, John D. Daigh Jr, MD, assistant VA inspector general for healthcare inspections warned that, “VHA is at risk of not performing its mission as the result of several intersecting factors. VHA has several missions, and too often management decisions compromise the most important mission of providing veterans with quality health care.”

Beyond localized issues, Dr. Daigh’s testimony pointed out a number of deficiencies at the VHA. He reported that the VISN structure lacked standardization and “has not worked effectively to support and solve problems facing hospitals.”

Dr. Clancy largely agreed with that assessment. “When the [VISN] networks were set about 20 years ago they were designed as laboratories of innovation… and that’s exactly what we got,” she told the committee. “The flip side is that we got a lot of inconsistency. We need to have our core processes be consistent wherever veterans seek our assistance.”

According to Dr. Daigh, technology systems at the VHA do not function adequately to meet current demands. “A number of VHA’s internal operations and systems, which should be seamless to providers, do not function well,” he pointed out. “The appointment system inefficiencies have contributed to wait time problems. Medical consultation software was permitted to devolve such that information within the system was not standard and in many cases not reliable.”

While promising to address the technology issues, Dr. Clancy also revealed that the VA is in the process of developing a new online platform called the Enterprise Health Management Platform (eHMP), which clinicians will use during their clinical interactions with patients. The system will include “Google-like search capabilities” and faster access to information than VistA, the current VA electronic health record system. According to Dr. Clancy, eHMP is already being piloted and is expected to roll out to 30 sites by the end of 2015. Full rollout, she promised, would be over the next 3 years.

Written testimony and the video of the committee meeting can be found here.