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Republican-Led VA Committee Sets Oversight Agenda

by U.S. Medicine

March 10, 2011

WASHINGTON, DC—At the top of the agenda for the 112th Congress’s House Veterans Affairs Committee (HVAC ) is stricter oversight of VA, something that the new Republican leader of the committee believes has been allowed to lapse. “It will be the top priority of this committee to ensure stringent oversight over veterans’ programs,” said Rep Jeff Miller, R-FL, who took the reins of the committee in January. “We must ensure that taxpayer dollars are being used efficiently to provide the best services and world class healthcare to the nation’s warriors and their families.”

The first move by the committee was to create an oversight plan—something they were required to do by February 15. The plan, released last month, contains 79 specific items that the full HVAC and its three subcommittees will focus on in the next couple of years, though Miller noted that it is open to revision and expansion.

Technology Issues

Many of the items the committee plans to focus on are perennial issues for VA. Information technology remains a high priority for all of the subcommittees. The department is still in the process of ironing out its centralized IT system—a project that the committee has kept a close eye on over the last few years.

Also, the committee plans to aggressively evaluate the progress of VA and DoD in creating a bi-directional, lifetime electronic healthcare record. The delay in this decade-long attempt by the two agencies to unite the records of their patient populations has been a source of continual frustration for Congress, which mandated the project in the first place. The committee will also be examining VA’s efforts at cyber-security. A number of high-profile security breaches over the last few years have been a source of embarrassment to the agency and created no small amount of friction between Congressional overseers and VA leadership.

According to the oversight agenda, the committee plans to review the effectiveness of VA’s Project Management Accountability System (PMAS) program. PMAS is an incremental development approach meant to ensure frequent delivery of new functionality to customers, coupled with a rigorous management approach that halts programs that fail to meet delivery milestones. This new system is designed for early identification and correction of failing IT programs.

Veterans’ Health

The same healthcare topics that dominated HVAC’s time over the last two years will continue to do so, it seems. PTSD, TBI, women’s health, substance abuse, and suicide prevention are all listed as oversight priorities. The committee will also evaluate VA’s plans to develop innovative methods of non-institutional long-term care—a need that becomes more pressing as the veteran population continues to age.

Also on the agenda is an examination of VA’s medical and prosthetic research program. Over the last few years, as recent victims of limb loss have moved from the DoD system to VA, there have been complaints that the prosthetics departments at individual VA medical centers do not live up to what servicemembers experienced at Walter Reed Army Medical Center.

One area of focus that has not received an abundance of attention in the past is pain management. In their oversight plan, the committee notes that pain management is becoming an increasingly significant issue, especially for returning combat veterans who are presenting with a wide range of physical and mental health problems. The HVAC subcommittee on health plans to focus on utilization of best practices for treating acute and chronic pain, as well as the challenge of potential abuse.

Addressing Spending

High on the committees’ list of priorities are issues that affect VA’s fiscal bottom line. Of particular concern to HVAC’s new leaders is fee-based care in VA, and how the department can better ensure accountability and transparency.

According to the committee, in FY2009, VA spent approximately $5.3 billion dollars (12% of its total medical care budget) to purchase healthcare services from non-VA entities, including other government agencies, affiliated universities, community hospitals, nursing homes, and individual providers. In 2009, the VA Office of Inspector General (IG) released an audit of VHA’s non-VA outpatient fee care program, which uncovered about $1.1 billion in overpayments over five years. The IG concluded that organizational structure changes were needed to make certain that fee basis care is properly authorized, justified, and met with consistent, reasonable, and proper payments.

How VA goes about acquiring medical and other supplies is another area that has been under review in the past, and will continue to be with this Congress. VA spends approximately $17 billion annually for pharmaceuticals, medical and surgical supplies, prosthetic devices, information technology, construction, and services. Previous HVAC hearings have shown that VA faces challenges in implementing a more efficient acquisition program, and the committee is planning to continue its examination of VA’s contracting, logistics, and control systems.

The subcommittee on health also plans to closely monitor the management of VA’s infrastructure, which includes more than 6,200 buildings on 300 sites across 32,000 acres.  Of particular concern to the committee is that many of VA’s facilities are more than 50 years old, and no longer suited for delivery of 21st century healthcare. Underutilized and vacant VA properties are estimated to cost $175 million annually, the committee’s oversight plan states. The committee’s list of goals includes identifying more sharing opportunities between VA and DoD; collaboration with medical affiliates; and making use of excess property through enhanced-use leasing or by selling the property.

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