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CRS — Health Care for Veterans: Answers to Frequently Asked Questions (April 30, 2015)

July 8, 2015 Comments off

Health Care for Veterans: Answers to Frequently Asked Questions (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), operates the nation’s largest integrated health care delivery system, provides care to approximately 5.75 million unique veteran patients, and employs more than 270,000 full-time equivalent employees.

CRS — Veterans’ Benefits: The Impact of Military Discharges on Basic Eligibility (3/6/15)

May 20, 2015 Comments off

Veterans’ Benefits: The Impact of Military Discharges on Basic Eligibility (PDF)
Source: Congressional Research Service (via Cornell University ILR School)

This report discusses the discharge or separation requirement for veteran status or, more specifically, how the VA assesses character of service to determine whether a former service member’s separation from the military can be considered other than dishonorable. In some instances, the military characterization of discharge is relatively uncomplicated, creating a binding entitlement to VA benefits (i.e., an honorable or general discharge [under honorable conditions]), assuming the individual meets other eligibility requirements for veteran status. However, if the characterization of discharge may preclude access to veteran’s benefits, the VA must develop the case, through an assessment of service records and other evidence related to a claimant’s time in the military. This report includes a hypothetical example (in Appendix C) illustrating the complexities associated with making character of service determinations by the VA.

Audit of VA’s Drug-Free Workplace Program

March 31, 2015 Comments off

Audit of VA’s Drug-Free Workplace Program
Source: U.S. Department of Veterans Affairs, Office of Inspector General

We conducted this audit to assess how effectively VA’s Drug-Free Workplace Program identifies and addresses illegal drug use among VA employees. VA needs to improve management of its Drug-Free Workplace Program. VA selected about 3 of every 10 applicants for pre employment drug testing before hiring these individuals into Testing Designated Positions (TDPs) in fiscal year (FY) 2013. We estimate that of the nearly 22,600 individuals VA reported hiring into TDPs in FY 2013, about 15,800 were hired without a pre-employment drug test. VA facilities tested about 68 percent of the 3,420 employees selected for random drug testing in FY 2013. We identified at least 19,100 employees in TDPs who were not subject to the possibility of monthly random drug testing.

In addition, VA erroneously designated as many as 13,200 employees in non-TDPs for drug testing in FY 2014. Further, only 17 (33 percent) of the 51 employees who tested positive for drugs as a result of reasonable suspicion of on-the-job drug use or after a workplace accident or injury were referred to VA’s Employee Assistance Program.

These issues occurred because VA does not support that all tentative selectees for TDPs need to be drug tested before being hired. VA also does not effectively monitor local facility compliance with random employee drug testing requirements. Furthermore, VA lacks adequate oversight to ensure the accuracy of drug testing data and that consistent personnel actions are taken when employees test positive for drugs. As a result, VA has little assurance that this program is performing as intended to identify and eliminate illegal drug use in its workforce.

Since VA’s workforce is expected to grow significantly with the passage of the Veterans Access, Choice, and Accountability Act of 2014, VA needs to take actions to address weaknesses in its Drug-Free Workplace Program immediately. We recommended the Deputy Assistant Secretary for Human Resources Management implement processes to ensure full compliance with VA’s pre-employment applicant drug testing and random employee drug testing requirements, and improve program integrity by ensuring the accurate coding of employees in TDPs.

The Acting Deputy Assistant Secretary for Human Resources Management concurred with our recommendations and provided an acceptable action plan. We will follow up on the implementation of the corrective actions.

Audit of VHA’s Home Telehealth Program

March 10, 2015 Comments off

Audit of VHA’s Home Telehealth Program
Source: U.S. Department of Veterans, Office of Inspector General

The goal of the Home Telehealth Program is to improve veterans’ access to care while reducing patient treatment costs. The program does this by remotely monitoring patients’ vital signs in the home and intervening early when adverse trends are detected. We determined how effectively the Veterans Health Administration (VHA) is managing its Home Telehealth Program. VHA missed opportunities to expand enrollment for Non-Institutional Care (NIC) patients in the Home Telehealth Program. NIC telehealth patients showed the best outcomes, in terms of reduced inpatient admissions and bed days of care (BDOC). In FY 2013, the number of NIC patients-served declined by 4 percent, while the number of Chronic Care Management (CCM) and Health Promotion/Disease Prevention (HPDP) patients-served grew 51 and 37 percent, respectively.

The significant change in the mix of patients receiving care in this program occurred due to a change in the performance methodology. VHA began to measure program performance by the total number of patients-enrolled, rather than focusing on the increase in enrollment for NIC patients. This change in performance metrics encouraged VHA to enroll more HPDP participants. These participants would likely need less intervention from Primary Care physicians, because their health care needs would be less complex. VHA was successful in reaching its new performance metric. However, obtaining this goal did not result in more patients with the greatest medical needs receiving care under the program. As a result, VA missed opportunities to serve additional NIC patients that could have benefited from the Home Telehealth Program. VA could have potentially delayed the need for long-term institutional care for approximately 59,000 additional veterans in FY 2013.

CRS — Health Care for Veterans: Suicide Prevention (January 30, 2015)

February 9, 2015 Comments off

Health Care for Veterans: Suicide Prevention
Source: Congressional Research Service (via Federation of American Scientists)

This report focuses on suicide prevention activities of the Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA). The VHA’s approach to suicide prevention is based on a public health framework, which has three major components: (1) surveillance, (2) risk and protective factors, and (3) interventions.

Audit of VHA’s National Call Center for Homeless Veterans

February 5, 2015 Comments off

Audit of VHA’s National Call Center for Homeless Veterans (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

Veterans Health Administration’s (VHA) National Call Center for Homeless Veterans (the Call Center) is VA’s primary vehicle for communicating the availability of VA homeless programs and services to veterans and community providers. OIG has assessed the effectiveness of the National Call Center for Homeless Veterans in helping veterans obtain needed homeless services.

We determined that Homeless and at-risk veterans (Homeless Veterans) who contacted the Call Center often experienced problems either accessing a counselor and/or receiving a referral after completing the Call Center’s intake process. Of the estimated 79,500 Homeless Veterans who contacted the Call Center in fiscal year (FY) 2013: Just under 21,200 (27 percent) could only leave messages on an answering machine—counselors were unavailable to take calls; almost 13,000 (16 percent) could not be referred to VA medical facilities—their messages were inaudible or lacked contact information; and approximately 3,300 (4 percent) were not referred to VA medical facilities, despite having provided all the necessary information.

Referred Homeless Veterans did not always receive the services needed because the Call Center did not follow up on referrals to medical facilities. Of the approximately 51,500 referrals made in FY 2013, the Call Center provided no feedback or improvements to ensure the quality of the homeless services. We noted that 85 percent of the 60 veterans’ records we reviewed lacked documentation to prove the veterans had received needed support services.

Finally, the Call Center closed just under 24,200 (47 percent) referrals even though the VA medical facilities had not provided the Homeless Veterans any support services. In total, we identified 40,500 missed opportunities where the Call Center either did not refer the Homeless Veterans’ calls to medical facilities or it closed referrals without ensuring Homeless Veterans had received needed services from VA medical facilities.

We recommended the Interim Under Secretary for Health stop the use of the answering machine, implement effective Call Center performance metrics to ensure Homeless Veterans receive needed services, and establish controls to ensure the proper use of Call Center special purpose funds. The Interim Under Secretary for Health concurred with our recommendations and provided responsive action plans. We will follow up on these actions.

OIG Determination of Veterans Health Administration’s Occupational Staffing Shortages

February 2, 2015 Comments off

OIG Determination of Veterans Health Administration’s Occupational Staffing Shortages (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The VA Office of Inspector General (OIG) conducted a determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages as required by Section 301 of the Veterans Access, Choice, and Accountability Act of 2014. We interpreted “largest staffing shortage” to encompass broader deliberation than simply the number needed to replace or backfill vacant positions. We performed a rules-based analysis on VHA data to identify these occupations. We determined that the five occupations with the “largest staffing shortages” were Medical Officer, Nurse, Physician Assistant, Physical Therapist, and Psychologist. This determination is the first of several OIG determinations on VHA occupational staffing shortages. We plan to incorporate additional data in future OIG determinations to provide more detailed recommendations. We recommended that the Interim Under Secretary for Health continue to develop and implement staffing models for critical need occupations.

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