Fiscal Year 2004 Performance and Accountability Report Published November 15, 2004
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FY 2004 Obligation ($ in Millions) |
% of Total VA Resources |
Strategic Goal 1: Restore the capability of veterans with disabilities to the greatest extent possible and improve the quality of their lives and that of their families. |
$41,459 |
59.3% |
Objective |
Performance Results
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1.1 Maximize the physical, mental, and social functioning of veterans with disabilities and be recognized as a leader in the provision of specialized health care services. |
- Increased to 86 percent the score on the Prevention Index II for special populations of veterans (goal was 80 percent)
- Increased to 79 percent the proportion of homeless veterans discharged from domiciliary or residential care settings to an independent or secured institutional living arrangement (goal was 67 percent)
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$13,121 |
18.8% |
Performance
VA's principal focus in the delivery of health care services is to provide timely, high-quality care to our core service population-service-connected disabled veterans, veterans with lower incomes, and veterans with special health care needs. During FY 2004 the Department continued to make progress toward achieving Objective 1.1, in part by establishing priority access to health care for veterans with service connected disabled conditions. VA worked with the Department of Defense (DoD) to ensure that veterans or Service members returning from Operation Enduring Freedom or Operation Iraqi Freedom with an injury or illness have timely access to VA's special health care services. This includes treatment for spinal cord injuries, traumatic brain injuries, post-traumatic stress disorder, prosthetics, and rehabilitation of the blind. In addition, VA established six new centers specializing in research, education, and clinical care for Parkinson's disease and two new centers specializing in studying the treatment of war-related illnesses among active duty military patients and veterans. With a strong emphasis on the provision of high-quality health care, VA raised its score on the Prevention Index II for special populations from 80 percent to 86 percent. This index charts the outcomes of nine medical interventions that measure how well VA follows national primary-prevention and early-detection recommendations for several diseases or health factors that significantly determine health outcomes for veterans with special needs, including those with disabilities. The Department was also successful in placing 79 percent of homeless veterans previously cared for in domiciliaries or other residential settings to independent living, halfway houses, or transitional housing. VA administers three special programs providing outreach, psychosocial assessments, referrals, residential treatments, and follow-up case management to homeless veterans.
Program Assessment Rating Tool (PART) Evaluation
During the development of the FY 2005 budget, the Administration conducted a PART evaluation of the medical care program that relates to the accomplishment of Objective 1.1. This assessment reviewed the combined effectiveness of the legislative and executive branches in designing and implementing the many aspects of VA's medical care program. The PART evaluation for the medical care program resulted in a rating of "Adequate," an improvement from the FY 2004 budget year PART rating of "Results Not Demonstrated." The improvement in the PART evaluation of the medical care program resulted from several factors, including VA's sharpening its focus on providing timely, high-quality health care to our highest priority veterans-those with service connected disabled conditions, veterans with lower incomes, and those with special health care needs.
VA's Office of Inspector General has identified the following health care issues as major management challenges related to Objective 1.1:
- Part-time physician time and attendance - implementation of management controls continues to need improvement to ensure that part-time physicians meet their employment obligations (more information).
- Staffing guidelines - lack of staffing standards for physicians and nurses continues to impair VA's ability to adequately manage personnel resources (more information).
- Quality management - senior hospital managers need to ensure that the quality management process is effectively maintained in all clinical departments (more information).
- Long-term health care - challenges remain in the community nursing home program, homemaker/home health aide program, and community residential program (more information).
- Security and safety - further work is needed to improve overall security, inventory, and internal controls over biological, chemical, or radioactive agents at VA health care facilities (more information).
- Management of violent patients - further steps need to be taken to enhance employee security in the management of violent patient events (more information).
The Government Accountability Office has identified the following health care issues as major management challenges related to Objective 1.1:
- Access - more needs to be done to ensure veterans receive the care they need, when they need it (more information).
- Long-term care - improvements are needed in nursing home inspections and increasing access to noninstitutional long-term care services (more information).
- Hepatitis C - further efforts are needed in screening and testing veterans for hepatitis C, notifying veterans who test positive, and evaluating veterans' medical conditions regarding potential treatment options (more information).
Program Evaluations
The Department is currently developing detailed plans for a program evaluation of the services for severely mentally ill patients. Four patient populations have been defined for study: schizophrenia; bi-polar; post-traumatic stress disorder; and major depressive disorder. These populations represent high-volume, high-cost patients. Patient-centered outcomes have been developed for each of the patient populations along a continuum of care from diagnosis and assessment, treatment, and chronic disease management through rehabilitation. In addition to the evaluation of outcomes for each diagnosis group, research questions will address other aspects of mental health treatment. These will include such areas as variations in availability of services, receipt of care for non-mental health diagnoses, barriers to access for care, and comparison of services and outcomes for non-VA patients.
The statement of work is currently being approved within VA. The evaluation is expected to be contracted to a firm in partnership with a university school of public health or medicine by the end of calendar year 2004. The study will take approximately 2 years to complete.
Booz Allen Hamilton and Northwestern University completed a program evaluation of the services provided by VA's Prosthetics and Sensory Aids Service in 2003. The specific populations studied included veterans at risk for amputations; lower extremity amputees; patients on home oxygen; patients who are legally blind, hearing impaired, or use motorized wheelchairs; and those at risk for additional heart attacks. Outcomes for each of these groups were developed and evaluated. In addition, the study evaluated VA contracts to provide home oxygen, veteran access to some new technologies, the effect of VA's program for those at risk for amputations, and the possibility for accreditation of VA's orthotics and prosthetics laboratories.
A major portion of the study evaluated the Preservation Amputation Care and Treatment Program, a program dedicated to caring for those at risk for amputations and those who already have had amputations. The results showed a program that is a model of care to prevent amputations being implemented differently across facilities, with a high percentage of veterans appropriately screened for risk. However, facilities with highly implemented programs did more amputations. Other results showed that VA is unique in providing computer access training and computer readers to veterans who show interest and capability, and a full 97 percent of blind veterans receive either a computer reader or a closed circuit television. VA also provides automated implantable cardiac defibrillators and motorized wheelchairs to those needing such devices. The study suggested that VA could do a better job of performing cochlear implants to those who could benefit from them. The study recommended that VA mandate that its orthotics and prosthetics laboratories become accredited.
New Policies and Procedures
Several new policies have been implemented recently that highlight our focus on our core service population in support of Objective 1.1. For example, VA has:
- Moved service-connected disabled veterans rated 50 percent or more to the top of the priority list for outpatient care.
- Provided priority access to medical care for all veterans returning from Gulf War duty, particularly those with service-connected disabled conditions.
- Suspended additional enrollments for new priority 8 veterans in order to ensure sufficient resources are available to care for veterans with military-related disabilities, lower incomes, or needing specialized care.
- Implemented additional programmatic and cost-sharing policies further aimed at focusing resources on the Department's core service population.
- Continued to work closely with DoD and other Federal agencies in such areas as interoperable computerized patient health data, improved data on insurance coverage, and enrollment and eligibility information to improve resource utilization.
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