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VA’s ‘Homegrown’ Mailing Processes Raise Drug Diversion Concerns

by Sandra Basu

October 7, 2017

By Sandra Basu

The VA’s mail order pharmacy in North Charleston, SC, one of seven in the United States.

WASHINGTON — Citing unreliable mail data and even the potential for drug diversion, lawmakers admonished VA to do a better job overseeing its mail system.

 “Veterans all over the country have pressing needs, and we simply cannot afford to operate this way anymore,” insisted Rep. Jack Bergman (R-MI), chairman of the House Committee on Veterans’ Affairs Oversight and Investigations Subcommittee.

Bergman made his remarks at a hearing last month on VA mail management.

Lori Rectanus, director of Physical Infrastructure for the Government Accountability Office (GAO), told lawmakers that VA reports sending more than 200 million pieces of mail to veterans and their dependents, including prescription medications and benefits or disability compensation information yet does not have reliable data on mail volume and expenditures.

“This is because it does not consistently track mail volume and cost across its facilities and administrations. Instead, every facility essentially does its own thing,” said Rectanus, citing findings from a July 2017 GAO report.

That report pointed out that VA’s reported $355 million mail volume and costs in 2016 are among the highest in the federal government, although the oversight group questioned the figures since data provided by the VA to the General Services Administration (GSA) is unreliable.

“For example, mail data for many facilities—including VA’s 1,055 community-based outpatient clinics and 300 vet centers—were not accounted for, while other facilities submitted mail expenditure data without mail volume, or volume data without expenditures,” the report stated. “Facilities also did not consistently report data on mail that was undeliverable as addressed.”

VA allows each administration and local facility to choose handle outgoing mail, according to the GAO. One area of particular concern is the VHA’s Consolidated Mail Order Pharmacy (CMOP) program, which includes seven facilities that mail 84 million parcels annually, filling approximately 80% of VA’s total prescriptions each year.

‘Homegrown’ Practices

In response, VA Office of Information Technology Executive Director for Privacy John Oswalt vowed VA would improve its mail management and plans to implement recommendations made by GAO.

“VA accepts and understands the need for immediate and decisive action and we are acting accordingly,” he said.

Oswalt explained that, in the past, VA mail operations have often had limited central oversight. Growth in mail volume, such as the shift toward pharmaceutical mailings instead of in-house pick-up, and the increase in the veteran population with more complex benefit and compensation issues, has “rendered these homegrown mailing practices obsolete,” he pointed out.

Now, Oswalt told lawmakers, VA must “eliminate inefficiency that impedes serving our veterans.”

            Subcommittee members expressed concern about the situation.

Citing the nationwide opioid crisis, Ranking Member Rep. Ann Kuster (D-NH) speculated about the security and tracking of VA packages, particularly pharmaceuticals.

“These issues place VA’s mail at risk and cause me to question whether the physical security and accurate tracking of packages, some of those packages containing opioids and controlled substances are at higher risk of diversion,” she said.

Earlier this year, the House Committee on Veterans’ Affairs held a hearing in which data from Jan. 2, 2014, through March 11, 2016, showed that VA had 2,405 reports of controlled substances internal and external losses, some of which were due to diversion. The data also showed that approximately 92% of controlled substances losses occured in the mailing system during shipping to the veteran.

“We’ve spoken with the USPS [on] the issues they are having with [drug] diversion. Do you have any kind of quality control around diversion?” she asked Oswalt.

Oswalt said he would look into the matter and get back to the committee.

Kuster also questioned whether, with 80% of VA’s prescriptions handled by CMOP, if VA has taken into account the mailing costs to calculate the true savings with such a high volume of prescriptions handled by the program.

            “This seems like an incredibly high percentage for mail order pharmacy,” she said.

House Committee on Veterans’ Affairs Chairman Phil Roe (R-TN) suggested that the amount VA spends on mail could actually be much higher or lower. He said VA should look at waste and inefficiencies and its use of electronic communication.

“I find it hard to believe that all of the mail VA sends is absolutely necessary,” he said.


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