Fiscal Year 2005 Performance and Accountability Report Published November 15, 2005
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VA is challenged to ensure that its enrolled veteran population has access to quality health care that is both timely and convenient. While VA continues to open community-based outpatient clinics, in its recently completed study conducted as part of its efforts to realign resources, VA identified a large number of geographic areas where veterans face long travel times to access VA outpatient care. To improve access, VA needs to strategically plan how best to use its resources and funding to provide equitable access to veterans needing acute care services, while also providing a growing elderly veteran population with institutional and noninstitutional long-term care services. VA also faces challenges in making blind rehabilitation and mental health care services, including those for post-traumatic stress disorder, more widely available to its enrolled veteran population. GAO made and VA concurred with recommendations to ensure more complete data for program monitoring and the availability of a range of long-term care, blind rehabilitation, and mental health programs services to veterans.
VA's Program Response to GAO1A:
VA continues implementing and refining Advanced Clinic Access (ACA), a patient-centered, scientifically based set of redesign principles and tools that enable staff to examine their processes and redesign them. Use of ACA results in improved access, quality, and efficiency; improved patient, staff, and provider satisfaction; and decreased costs. The implementation of ACA requires health care delivery teams to eliminate delays by measuring supply and demand, reducing and shaping demand, increasing supply, reducing backlogs, decreasing appointment types, developing contingency plans, flow-mapping delivery processes, and improving office efficiency.
In addition to working on ACA, VA has added a network-level performance measure on access to home and community-based care services. The measure addresses improved access to care and program expansion across VHA's 21 networks. VA continues to monitor multiple workload and other descriptive measures of long-term care programs. Data on unique veterans, visits, census, and eligibility priority groups are now routinely collected and analyzed.
VA continues expanding access to specialty post-traumatic stress disorder (PTSD) care. Thirty-one new or expanded PTSD programs were funded in 2005, including eight new PTSD clinical teams, two new day hospitals, and three new women's programs, in addition to several new military sexual trauma programs. Several programs for veterans with both PTSD and substance abuse disorders are currently being developed. Innovative use of tele-mental health in community-based outpatient clinics (CBOCs) and other rural-support PTSD programs have also been funded. Mental health capabilities in CBOCs are being increased in recognition of the demand for services with additional available funding.
Returning Veterans Outreach, Education, and Care programs are being established in 34 areas where there are high numbers of returning veterans. These programs will provide preventive health training and associated psychosocial supports to returning veterans as well as identify those in need of treatment for specific mental disorders. One hundred new Vet Center counselors are in the process of being hired from among the ranks of returning Operation Enduring Freedom and Operation Iraqi Freedom servicemembers.
VA continues to improve its capacity to make blind rehabilitation services more widely available and to ensure that program data are managed efficiently. Monthly statistical reports on waiting times are being submitted to and monitored by VHA's Blind Rehabilitation Service (BRS). A directive specifying procedures for processing applications to BRS programs and how to calculate the wait times for admission to inpatient Blind Rehabilitation Centers is expected to be published by the end of the first quarter of 2006, along with a BRS handbook that reflects the standardized calculation of wait times. The existing national database that is currently used for reporting purposes is being updated to ensure efficient and standardized reporting of wait times and the processing of applications. The updated database is also expected to be released to the field by the end of the first quarter of 2006.
VA has created a new basic care patient class for legally blind veterans in the Veterans Equitable Resource Allocation (VERA) priority group 4. This patient class will better align VERA allocations with patient care costs for these veterans and will enable networks to expand outpatient services to blinded veterans. VA continues to utilize private vendors whenever appropriate to provide blinded veterans training in the use of computers.
In addition, VA must also ensure the safety of veterans in two ways. First, GAO recommended that VA conduct more thorough screening of the personal and professional backgrounds of health care providers to minimize the chance of patients receiving care from providers who may be incompetent or who may intentionally harm them. Second, VA needs to strengthen its human subject protections program by addressing continuing weaknesses in the program. VA created a task force to review its screening policies for health care employees, and its research offices have updated VA's human subject protections policies.
VA's Program Response to GAO1B:
VA is implementing primary source verification of all licenses, registrations, and certification and expanding the credentialing process for all licensed, registered, and certified health care personnel. During 2005, VA achieved full compliance in credentialing all physician assistants and advanced practice registered nurses using VetPro. VetPro is VA's Web-based credentialing data bank. Software modifications have been made to VetPro to allow it to serve as a verifying tool for all VHA existing state licenses and national certificates, and staff have been trained in its use. Full implementation is expected once an issue currently with the Office of General Counsel concerning hybrid title 38 positions and bargaining unit issues is resolved. In addition, VHA's National Leadership Board approved a requirement for fingerprint checks to be extended to VHA employees (whether paid or without compensation), trainees, volunteers, and contractors. VA has implemented an oversight program to monitor the effectiveness of screening of practitioners.
VA has instituted a number of steps to strengthen its human research protection programs including staff training, conference calls, and research program accreditation by the National Committee for Quality Assurance. In 2005, 48 VA facilities were accredited, with the goal of having all facilities accredited by the end of calendar year 2006.
In the past calendar year, VA's Office of Research Oversight (ORO) has carried out considerable activities to advise the Under Secretary of Health on matters of compliance and assurance in human subjects protections in accord with its statutory mandate. ORO conducted on-site reviews to evaluate possible serious research improprieties, as well as prospective reviews to evaluate compliance with current federal laws, regulations, and VA policies governing research involving human subjects. In addition, information was disseminated to the field concerning human subject protections. ORO continues managing and handling cases of possible noncompliance. ORO is now developing a handbook concerning VA requirements for and responsibilities in assurance development, which is expected to be released to the field in calendar year 2006. In addition, ORO launched a quality assurance initiative to review Institutional Review Board (IRB) minutes of all IRBs of record for all VA facilities for compliance with regulations and policies.
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