In March, Nicole Hyke, inventory manager with the Milwaukee VAMC, looked over chest tube kits she assembled in order to meet patient needs when supply-chain issues exhausted the hospital’s supplies. VA photo
WASHINGTON, DC — Each report the Government Accountability Office (GAO) submits to VA detailing weaknesses in the department comes attached with recommendations for solving the problems. While VA addresses the majority of these recommendations, a total of 208 made by GAO over the past four years remain open, some dealing with high-risk areas that impact veteran healthcare.
Last month, GAO wrote a letter to VA Secretary Denis McDonough with a report detailing what it considered the most-pressing recommendations, urging him to push the department to address them. The two types of recommendations on GAO’s high-risk list are in the areas of Acquisition Management and Managing Risks and Improving VA Healthcare.
Problems with VA’s acquisition management system came into stark relief during the pandemic as the agency struggled to track medical supplies within its facilities.
“Federal agencies, including VA, face significant, long-standing acquisition management challenges that increase the risk of waste and mismanagement,” the GAO report stated. “For example, in March 2021, we testified that the COVID-19 pandemic exposed problems in VA’s supply chain management and highlighted the need for a comprehensive supply chain management strategy. Fully implementing [our] priority recommendations, such as using a balanced set of performance metrics to manage the department’s procurement organizations, would help improve VA’s acquisition management.”
Supply chain management has long been a challenge for VA, and its most-recent modernization efforts have been fraught with problems. In 2018, the department chose to move to the Defense Medical Logistics Standard Support (DMLSS) system, which is used by the Defense Logistics Agency. However, a report last year from the VA Office of the Inspector General (OIG) found the system failed to meet many of the needs of VA employees at the system’s pilot site, and a federal court ruling in July 2021 put a halt to shifting medical and surgical contracts to the new system.
VA also is lacks a comprehensive supply chain management strategy or useful performance metrics to judge its own progress, the GAO report stated.
The high-risk area “Managing Risks and Improving VA Healthcare” encompasses a number of recommendations, including creating an adequate wait-time performance measure for community care, developing a method to track how many physicians (both VA and non-VA) are actually providing care at each facility and developing a department-wide succession plan for VA leadership so that there is a smooth handoff as new people come in. The lack of consistent leadership has been raised in numerous GAO and OIG reports, which note how not having a consistent vision can negatively impact major VA projects, such as the Electronic Health Record Modernization program.
As for counting the number of physicians at each medical facility–that was one of the recommendations that VA disagreed with. Officials told GAO that their inability to count physicians does not affect a facility’s ability to assess workload–a statement that GAO officials were highly skeptical of.
The report also highlighted the need to create meaningful distinctions between VA employee ratings.
“VA needs to develop and implement a process to standardize performance plan elements, standards, and metrics for common positions across VHA,” the report noted. “Until VA finalizes its revised performance management policy, which it estimated placing into concurrence no later than the third quarter of fiscal year 2022, VA may not be positioned to make meaningful distinctions in employee performance.”
GAO also is concerned about VA’s ability to provide timely care to veterans. The agency has recommended that VA work to identify areas that need improvement so that it can mitigate problems that contribute to long wait times, as well as develop an effective oversight process that ensures adequate monitoring of the department at the VISN level.
According to VA officials, its new scheduling system will be key to addressing these recommendations. The department plans to deploy the scheduling system faster than the larger, now-stalled, EHR, with a nationwide completion date of 2027.
GAO officials would still like to know specifics of how the scheduling system will provide a fix for these issues.
“VHA should clarify its existing policy and provide additional details and documentation regarding how the new scheduling system will address these concerns,” GAO officials stated in the report. “Until VHA improves the reliability of its medical appointment wait time measures, VHA is less equipped to identify areas that need improvement and mitigate problems that contribute to longer wait times.”