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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.

VA OIG — Review of Alleged Mismanagement of VA’s Office of Public and Intergovernmental Affairs Outreach Contracts

January 7, 2015 Comments off

Review of Alleged Mismanagement of VA’s Office of Public and Intergovernmental Affairs Outreach Contracts (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

We evaluated the merits of Hotline complaints that VA’s Office of Public and Intergovernmental Affairs (OPIA) awarded an outreach contract to Woodpile Studios, Inc., alleging that it yielded no apparent increase in the use of VA healthcare, benefits, or services by veterans and then planned to solicit new outreach contracts without evaluating the effectiveness of the prior contract.

We substantiated the allegations regarding OPIA mismanagement of its outreach contracts. We confirmed that in July 2010, OPIA awarded a contract to Woodpile Studios, Inc. to provide support for outreach campaigns at an initial cost of $5.2 million. However, OPIA could not demonstrate that contract activities resulted in increased awareness of and access to VA healthcare, benefits, and services for veterans.

We also confirmed that OPIA solicited significant new outreach service contracts without evaluating the effectiveness of the previous contract. OPIA management stated that leadership turnover contributed to ineffective oversight of the outreach contract management and solicitations. Consequently, Woodpile contractors performed functions that were inherently Governmental. Questionable use of a labor-hour order instead of a performance-based contract contributed to invoices for activities that did not clearly link to accomplishment of VA outreach goals.

By awarding new contracts without first evaluating the performance of the prior Woodpile contract, OPIA continued to expend funds on questionable outreach activities. OPIA also lacked performance metrics to fully assess improvements in access to VA benefits and services for veterans.

We recommended that the Assistant Secretary for the Office of Public and Intergovernmental Affairs ensure effective oversight of outreach contract management and prevent contractors from performing inherently Governmental tasks. The Assistant Secretary should also implement metrics to ensure the outreach campaigns improve veteran awareness and access to VA services.

The Acting Assistant Secretary for the Office of Public and Intergovernmental Affairs concurred with our report recommendations and summarized corrective actions for our consideration. We will monitor implementation of the corrective action plans.

See also: Audit of VHA’s Support Service Contracts (PDF)

VA Mental Health Services Public Report — November 2014

December 10, 2014 Comments off

VA Mental Health Services Public Report — November 2014 (PDF)
Source: U.S. Department of Veterans Affairs

The following report is designed to give Veterans, their families, and the broader community information about the mental health treatment programs offered by the Department of Veterans Affairs (VA). It documents the rapid growth in demand for VA mental health services during the past decade, some of the challenges this has created, and ways in which VA has responded. VA measures the resources available to address Veterans’ mental health needs, and this report highlights some of these, including budgeting for mental health care, staffing and space for mental health programs, and use of technology to improve access to treatment. The report also presents information about Veterans’ experience of care, including the types and amount of mental health services received and Veterans’ opinions about access and quality of care. VA has ongoing efforts to use this information to address areas of concern and improve the quality of VA mental health treatment.

PTSD Research Quarterly — Impact of Mass Shootings

October 28, 2014 Comments off

PTSD Research Quarterly — Impact of Mass Shootings (PDF)
Source: National Center for PTSD (VA)

Norris (2007) provided an excellent introduction to the literature on mass shootings. Our goal is to provide an update on this literature. Norris focused on individual, as well as broader community factors in examining responses to mass shootings. Our guide focuses solely on quantitative studies examining factors at the level of the individual that appear to be related to adjustment following a mass shooting.

Our definition of a mass shooting involves an individual (with few exceptions, a male), acting alone and with generally personal rather than political motivation, entering a densely populated space and shooting as many people as possible. In addition, while not required in the definition, the shooter typically takes, his or her, own life. Our guide to the literature proceeds chronologically, with an emphasis on studies that use longitudinal data.

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