Archive for the ‘Government Accountability Office’ Category

High Interest GAO Report — Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence

April 29, 2015 Comments off

Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence
Source: Government Accountability Office

Advance directives, such as living wills or health care powers of attorney, specify—consistent with applicable state law—how individuals want medical decisions to be made for them should they become unable to communicate their wishes. Many individuals receive medical care from Medicare and Medicaid funded providers during the last 6 months of life, and may benefit from having advance directives that specify treatment preferences. According to IOM, advance directives are most effective when part of a comprehensive approach to end-of-life care called advanced care planning.

GAO was asked to review information related to advance directives. This report examines (1) how CMS oversees providers’ implementation of the PSDA requirement; (2) what is known about the approaches providers use and challenges they face to inform individuals about advance directives; and (3) what is known about the prevalence of advance directives and how it varies across provider types and individuals’ demographic characteristics. To do this work, GAO reviewed CMS documents and survey data reported by state survey agencies into CMS’s Certification and Survey Provider Enhanced Reporting system about covered providers’ implementation of the PSDA requirement. GAO also conducted a literature review of peer reviewed articles and federal government reports. In addition, GAO interviewed CMS officials and stakeholders representing providers and individuals likely to benefit from advance directives.

GAO — 2015 ANNUAL REPORT: Additional Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits

April 15, 2015 Comments off

GAO — 2015 ANNUAL REPORT: Additional Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits
Source: Government Accountability Office

GAO’s 2015 Annual Report identified 12 new areas of fragmentation, overlap, and duplication in federal programs and activities. GAO also identified 12 new opportunities for cost savings and revenue enhancement. Related work and GAO’s Action Tracker—a tool that tracks progress on GAO’s specific suggestions for improvement—are available here.

What GAO Found
+ In its 2015 report, GAO presents 66 actions that the executive branch or Congress could take to improve efficiency and effectiveness across 24 areas that span a broad range of government missions and functions.

+ GAO suggests 20 actions to address evidence of fragmentation, overlap, or duplication in 12 new areas across the government missions of defense, health, income security, information technology, and international affairs.

+ GAO also presents 46 opportunities for executive branch agencies or Congress to take actions to reduce the cost of government operations or enhance revenue collections for the Treasury across 12 areas of government.

High Interest GAO Report — Library of Congress: Strong Leadership Needed to Address Serious Information Technology Management Weaknesses

March 31, 2015 Comments off

Library of Congress: Strong Leadership Needed to Address Serious Information Technology Management Weaknesses
Source: Government Accountability Office

What GAO Found

The Library of Congress has established policies and procedures for managing its information technology (IT) resources, but significant weaknesses across several areas have hindered their effectiveness:

Strategic planning: The Library does not have an IT strategic plan that is aligned with the overall agency strategic plan and establishes goals, measures, and strategies. This leaves the Library without a clear direction for its use of IT.

Investment management: Although the Library obligated at least $119 million on IT for fiscal year 2014, it is not effectively managing its investments. To its credit, the Library has established structures for managing IT investments—including a review board and a process for selecting investments. However, the board does not review all key investments, and its roles and responsibilities are not always clearly defined. Additionally, the Library does not have a complete process for tracking its IT spending or an accurate inventory of its assets. For example, while the inventory identifies over 18,000 computers currently in use, officials stated that the Library has fewer than 6,500. Until the Library addresses these weaknesses, its ability to make informed decisions will be impaired.

Information security and privacy: The Library assigned roles and responsibilities and developed policies and procedures for securing its information and systems. However, its implementation of key security and privacy management controls was uneven. For example, the Library’s system inventory did not include all key systems. Additionally, the Library did not always fully define and test security controls for its systems, remediate weaknesses in a timely manner, and assess the risks to the privacy of personal information in its systems. Such deficiencies also contributed to weaknesses in technical security controls, putting the Library’s systems and information at risk of compromise.

Service management: The Library’s Information Technology Services (ITS) division is primarily responsible for providing IT services to the agency’s operating units. While ITS has catalogued these services, it has not fully developed agreements with the other units specifying expected levels of performance. Further, the other units were often not satisfied with these services, which has contributed to them independently pursuing their own IT activities. This in turn has resulted in units purchasing unnecessary hardware and software, maintaining separate e-mail environments, and managing overlapping or duplicative IT activities.

Leadership: The Library does not have the leadership needed to address these IT management weaknesses. For example, the agency’s chief information officer (CIO) position does not have adequate authority over or oversight of the Library’s IT. Additionally, the Library has not had a permanent CIO since 2012 and has had five temporary CIOs in the interim.

In January 2015, at the conclusion of GAO’s review, officials stated that that the Library plans to draft an IT strategic plan within 90 days and hire a permanent CIO. If it follows through on these plans, the Library will be in a stronger position to address its IT management weaknesses and more effectively support its mission.

GAO Adds IT Acquisitions and Operations and VA Health Care to Latest High Risk List

February 11, 2015 Comments off

GAO Adds IT Acquisitions and Operations and VA Health Care to Latest High Risk List
Source: Government Accountability Office

The Government Accountability Office (GAO) today released its biennial High Risk List and announced the addition of two new areas: “IT Acquisitions and Operations” and “Veterans Affairs Health Care.”

“Too frequently, federal IT investments fail to be completed or incur cost overruns and schedule slippages while contributing little to mission-related outcomes. And for several years we have reported on the need to improve health care for our nation’s veterans, but more than 100 of our recommendations still have not been addressed. So it is critical to add these issues to the list and bring sustained attention to finding and implementing solutions,” said Gene L. Dodaro, Comptroller General of the United States and head of the GAO.

Dodaro said he was pleased that so many other areas have seen progress over the past two years and weaknesses are being identified and addressed. “I really have to thank the combined efforts of Congress, agency officials and staff, and the Office of Management and Budget in helping to move so many issues into positions where they have a better chance of being removed from the list entirely in the years to come,” Dodaro said. Of the 30 areas that were on the 2013 list, 18 areas at least partially met all the criteria for removal. Dodaro will testify on the list at hearings today before the Senate Committee on Homeland Security and Governmental Affairs and the House Committee on Oversight and Government Reform.

With the two areas added today, GAO’s 2015 High Risk List includes a total of 32 federal operations that represent areas at high risk for waste, fraud, abuse or mismanagement, or are in need of broad-based transformation. Two high-risk issues—”Protecting Public Health through Enhanced Oversight of Medical Products” and “DOD Contract Management”—demonstrated enough progress to narrow their scope. Overall, 28 high-risk areas were rated against the five criteria and of these, 87 percent were rated as met or partially met.

GAO has also expanded two areas on the 2015 list in response to evolving concerns. “Enforcement of Tax Laws” will include the Internal Revenue Service’s efforts to address tax refund fraud due to identify theft. “Ensuring the Security of Federal Information Systems and Cyber Critical Infrastructure and Protecting the Privacy of Personally Identifiable Information” has been expanded because of the privacy threats that technological advances pose to personally identifiable information.

New this year are area ratings that use star-shaped graphics to indicate degrees of progress in meeting five criteria for removing an area from the High Risk List. The five criteria are: (1) leadership commitment, (2) agency capacity, (3) an action plan, (4) monitoring efforts, and (5) demonstrated progress. GAO’s area ratings are intended to provide greater transparency and specificity to agency officials seeking to make changes.

Updated biennially at the start of each new Congress, lawmakers use the High Risk List to help set oversight agendas, and both the legislative and executive branches have turned to GAO’s findings to help devise agency-specific as well as government-wide solutions.

New From the GAO

February 6, 2015 Comments off

New GAO Reports
Source: Government Accountability Office

1. Mental Health: HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness. GAO-15-113, December 18.
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2. International Classification of Diseases: CMS’s Efforts to Prepare for the New Version of the Disease and Procedure Codes. GAO-15-255, January 28.
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New From the GAO

February 3, 2015 Comments off

New GAO Report
Source: Government Accountability Office

U.S. Commission On Civil Rights: Management Improvements Are Needed to Better Achieve Its Mission. GAO-15-92, February 3.
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New From the GAO

January 30, 2015 Comments off

New GAO Reports
Source: Government Accountability Office

1. Defense Health Care: Additional Information Needed about Mental Health Provider Staffing Needs. GAO-15-184, January 30.
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2. Federal Workforce: OPM and Agencies Need to Strengthen Efforts to Identify and Close Mission-Critical Skills Gaps. GAO-15-223, January 30.
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