The Veterans Health Administration’s Governance of Robotic Surgical System Investments Needs Improvement

The VA Office of Inspector General (OIG) examined whether the Veterans Health Administration (VHA) adequately governs its purchase and use of robotic surgical systems. Employees at VA medical facilities submit applications to the VHA Office of Healthcare Technology Management to purchase these systems. The office reviews applications and recommends them to the assistant deputy under secretary for health for administrative operations for final approval. The systems cost between $1.5 million and $2.2 million each, including parts and maintenance. The OIG found VHA did not consistently support its acquisition of robotic surgical systems as required by VA policy. Between June 2013 and September 2018, the office recommended approving 45 applications. Of these, 13 systems had incomplete information to support a justification. In addition, 10 systems did not have documented evidence of final approval before acquisition. VHA also did not have comprehensive data on robotic surgeries. VHA’s National Surgery Office reported about 2,300 fewer procedures than the manufacturer of the robotic systems had recorded during fiscal year 2018. The manufacturer’s data was based on information the robotic systems automatically captured for each procedure. VHA underreported the number of robotic surgical procedures because medical facility staff coded them inconsistently in VA’s electronic health information system. VHA concurred with all OIG recommendations, including that VHA provide clearer instructions for preparing and supporting applications for high-cost, high-tech medical equipment and ensure applications are reviewed and validated before they are recommended for final approval. VHA also agreed to evaluate the need and justification for the 10 surgical systems acquired without final approval. Finally, in response to OIG recommendations, VHA will develop guidance for coding robotic surgical procedures accurately and consistently and evaluate whether the National Surgery Office needs to obtain data from the system manufacturer to validate VHA data.