While the Department of Veterans Affairs has implemented clinical productivity metrics as well as statistical models to track clinical efficiency, the VA is coming up short in terms of collecting data on its healthcare providers and medical centers, according to a new Government Accountability Office audit.

Contrary to federal internal control standards, the VA’s metrics and models may not provide quality information because the data is incomplete, the GAO found.

In addition, auditors reported that the agency does not systematically oversee efforts by VA medical centers (VAMCs) to monitor clinical productivity and efficiency.

“As a result, VA cannot systematically identify best practices to address low productivity and inefficiency as well as determine the factors VAMCs commonly identify as contributing to low productivity and inefficiency,” states the report.

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Specifically, GAO identified four limitations with the agency’s metrics and models that limit its ability to assess whether resources are being used effectively:

  • Productivity metrics are not complete because they do not account for all providers or clinical services. In particular, the metrics do not capture all types of providers who deliver care at VAMCs, including contract physicians and advanced practice providers, such as nurse practitioners, serving as sole-providers. Further, the metrics do not capture providers' workload evaluating and managing hospitalized patients.
  • These metrics may not accurately reflect the intensity—the amount of effort needed to perform—clinical procedures or services. Consequently, the VA’s productivity metrics may not accurately reflect provider productivity, as differences between providers may represent coding inaccuracies rather than true productivity differences.
  • The metrics may not accurately reflect providers’ clinical staffing levels. According to the GAO, 5 of 6 selected VAMCs auditors visited reported that providers do not always accurately record the amount of time they spend performing clinical duties, as distinct from other duties.
  • Efficiency models may also be adversely affected by inaccurate workload and staffing data. To the extent that the intensity and amount of providers' clinical workload are inaccurately recorded, some of VA’s efficiency models examining VAMC utilization and expenditures may also be inaccurate.

To address these data concerns, auditors recommended that the VA Secretary direct the Undersecretary for Health to take the following actions:

  • Expand existing productivity metrics to track the productivity of all providers of care to veterans by, for example, including contract physicians who are not VA employees as well as advance practice providers acting as sole providers.
  • Ensure the accuracy of underlying staffing and workload data by, for example, developing training to all providers on coding clinical procedures.
  • Develop a policy requiring VAMCs to monitor and improve clinical efficiency through a standard process, such as establishing performance standards based on VA’s efficiency models and developing a remediation plan for addressing clinical inefficiency.
  • Establish an ongoing process to systematically review VAMCs’ remediation plans and ensure that VAMCs and Veterans Integrated Service Networks are successfully implementing remediation plans for addressing low clinical productivity and inefficiency.

VA officials were not immediately available for comment. However, in a written response to the GAO report, the agency concurred or concurred in principle with the GAO’s recommendations.

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