United States General Accounting Office GAO Health, Education, and Human Services Division September 1997 Veterans Affairs and Military Health Care Issues Issue Area Plan for Fiscal Years 1998-99 . . Foreword As the investigative arm of the Congress and the nation’s auditor, the General Accounting Office is charged with following the federal dollar wherever it goes. Reflecting stringent standards of objectivity and independence, GAO'S audits, evaluations, and investigations promote a more efficient and cost-effective government; expose waste, fraud, abuse, and mismanagement in federal programs; help the Congress target budget reductions; assessfinancial and information management; and alert the Congress to developing trends that may have significant fiscal or budgetary consequences-In fuhilhng its responsibilities, GAO performs original research and uses hundreds of databases or creates its own when information is unavailable elsewhere. To ensure that GAO'S resources are directed toward the most important issues facing the Congress, each of GAO'S 33 issue areas develops a strategic plan that describes the signi6cance of the issues it addresses, its objectives, and the focus of its work. Each issue area relies heavily on input Tom congressional committees, agency officials, and subjecematter experts in developing its strategic plan. The Veterans’Affairs and Military Health Care issue area covers health care services provided to veterans and military beneficiaries through the systems of hospitals and clinics of the Department of Veterans’Affairs (VA) and the Department of Defense (DOD). We also examine health care provided by the Indian Health Service and Bureau of Prisons. Our work at VA also evaluates programs providing certain nonhealth benefits, such as disability compensation and pensions, to veterans and their dependents or survivors. The principal issues covered by this strategic plan are . identifying opportunities to improve existing VA and DOD health care systems’and VA benefit programs’management and accountability; l assessing efforts to structurally reform the VA and DOD health care and VA benefits systems to better accomplish their missions; l evaluating the implementation of, and lessons learned from, managed health care strategies in VA and DOD; and l determining whether federal agencies are effectively serving the unique health needs of special populations. In the pages that follow, we describe our key planned work on these issues. Page 1 GAO/UP-97-2 1 Foreword :r , Because events may significantly affect even the best of plans and because periodic measurement of success against any plan is essential, our planning process allows for updating and responding quickly to emerging issues. If you have any questions or suggestions about this plan, please call me at (202) 512-7101. Stephen P. Backhus Director, Veterans’Affairs and Military Health Care Issues Cl Page 2 GAO/UP-97-21 Contents Foreword Table I: Key Issues Table II: Planned Major Work Table III: GAO Contacts Page 3 -‘i’TableI: Key Issues Significance Improving management and VA and DOD operate two of the largest health care systems In the world; in addition, VA accountability: How can existrng VA and delivers a wide array of nonmedrcal benefits to the natron’s veterans VA’s 222,000 DOD health care systems and VA benefits workers deliver services in more than 1,000 facrlitres at a cost of over $38 billion annually programs be better managed? DOD’s health system currently includes some 115 hospitals and 471 clinics operating worldwlde and employs about 146,000 civilian and mrlrtary personnel at an annual cost of over $15 blllron The VA and DOD health care systems also play important roles rn trarning healthcare professionals, conducting medical research, and testing advanced medical technologies and services. VA and DOD face many management challenges in delivering servrces and benefits and improving performance through a focus on results and accountabrlrty Reforming VA and DOD: VA and DOD health care systems face increasing challenges and competrtron from a ’ Can VA and DOD health and VA benefit changing health care marketplace as well as pressures to reduce health care costs As systems be restructured to better VA’s inpatient population continues to shrink sharply because of declining numbers of . accomplish their missions? veterans and changes in health care practices, the economtc viability of VA hospitals is threatened The military health care system must adjust to substantial reductions in the overall size of the nation’s military forces. Pressure to reduce the deficit also increases attentron on nonhealth benefits for veterans, and their dependents and survivors, where there are significant issues regarding elrgrbility and potential overlap and duplication rn delivery systems Moving to managed care strategies: How Nationwide changes In the practice of medicine are having an effect on the VA and DOD effectively are the VA and DOD health care health care systems In partrcular, managed care rnrtratrveshave been widely adopted In systems implementing managed care the private sector and in other government programs and are being Implemented in rnltlatlves? DOD’s TRICARE program By September 1997, DOD expects to have implemented TRICARE nationwide to serve more than 5 million beneficiaries VA IS changing the way physrcrans practice by moving from provrding eplsodrc specialized care to a patient- based primary care model, a move long embraced by health maintenance organizations The Congress will continue to seek assessments of how these efforts are progressing and identify lessons learned P li ,,-- * _ -- -- ’ -Serving special populations: VA and DOD face challenges as they seek to ensure access and provrde quality care to How effectively IS the federal government indrvrduals with special health care needs Veterans In need of post-traumatic stress delrvenng specialized health and related disorder treatment or long-term psychratnc care, for example, face space and resource services? limits in VA programs As a result, some of these veterans have been unable to receive the specralrzed care they need Moreover, Persian Gulf veterans have reported an array of medical problems which they attribute to their service In the Perstan Gulf, and have sought VA medical treatment and compensation In addition, the federal government delivers health care through the lndran Health Service and Bureau of Prisons and needs to ensure that these services are delivered cost-effectlvelv Page 4 GAO/UP-97-21 Table I: Key Issues Objectives Focus of work 1. Identify more effective management controls to mtnlmrze fraud, waste, and abuse l Examtne DOD and VA controls over payments to contractors and benefrcrarres. 2 Identify opportunities for cost savings through legislative or admrnistratrve changes that l Assess DOD and VA efforts to avord Improve overall operatlonal efficiency double billing and obtain reimbursements . Examine DOD health systems’ and VA’s 3 Assess the effectiveness of VA’s and DOD’s strategic plannrng efforts budgeting and spending activities l Monitor VA’ s efforts to modernize Its information systems and technology l Examine VA’ s and DOD’s efforts to develop goals and measures that focus on program results 1 Identify alternatives available to VA for reforming its benefits programs l Examtne VA’ s efforts to restructure its benefits programs. 2 Identify needed changes in military medicine organizatton and structure rn response to l Assess DOD’ s plans and progress rn changes in mrlltary force size, requirements, and threats decentrallzrng functions and consolldatrng _ and downsizing medical facrlrtles 3 identify alternative ways that VA and DOD could jointly provide health care and benefits. l Identify opportunities for DOD and VA to consolidate programs and share resources 1 Identify ways to improve DOD’s managed care implementation for beneficiaries and the l Assess DOD’ s progress in Implementing, government and the cost-effectiveness of, TRICARE l Examine TRICARE financing and 2. Monitor VA’s efforts to move from inpatient to outpatient health care contractor performance l Assess DOD efforts to develop 3 Examine VA and DOD efforts to serve veterans and retired military personnel in a performance goals and measures for managed care environment TRICARE l Assess VA policies, plans, and progress in shifting from a hospital-based to a more ambulatory, primary care system l Examrne options for meeting long-term care needs l Assess VA and DOD Medicare subvention initiatives 1. Assess VA’s efforts to meet the health needs of special veteran populations l Assess the adequacy and effectiveness of VA’s response to veterans’ specialized health needs l Examine the effects of VA’ s health system restructuring on special veteran populations Page 5 2,‘ ,-; : r :$!-’ ??‘able II: Planned Major W o rk :;A :, Issue Planned maior iob starts Improving management and -Adequacy of DOD medical facilitres’and TRICARE contractors’third-party collections accountability -VA ‘s quality assurance program for compensation and pension claims -Extent of duplicate billings under VA’s fee basis and contract hospital and nursing home programs -DOD malpractice cost increases -Examine DOD health budgeting activities -Merits of postemployment restrictions on former DOD officials -VA budgeting Issues and activities -Navy graduate medical education programs -VA’s Alabama hospital integration plan -VA information technology and systems modernization -DOD information technology and systems -VA’s efforts to develop an integrated departmentwide strategic plan -DOD’s measures for monitoring medical facilities’ and contractors’performance in providlnq health care access . Reforming VA and DOD -Examine proposed use of state cemeteries for veteran burials -DOD’s pharmacy programs -Mllltary hospital competitiveness -Potential for consolidating military medical facilities in the national capitol region * -Assess the merits of VA and DOD Jointventures -Level of VA participation as TRICARE provider -Assess the need for seoarate VA and DOD disabilitv comoensatlon oroarams Moving to managed care strategies -Overview and status of TRICARE rmplementation -Cost neutrality of TRICARE -TRICARE contractor reporting requirements’consistency with GPRA’s focus on results -Extent of DOD consulting contracts -VA eligibility reform impiementatlon -Veterans Equitable Resource Allocation/Veterans Integrated Service Networks impact on health care access and quality -VA’s expanded contracting authority for health services -VA and DOD efforts to train specialists for primary care responslbllitres -VA role In providing long-term care -Medicare subvention options Serving special populations -Persian Gulf rllness -VA’s handling of Persian Gulf War veterans’claims -Appropnateness of disability ratings for Persian Gulf War veterans -Impact of VA eliglbllity reform on special emphasis programs -Health care available to women veterans Page 6 GAomP-97-21 Table III: GAO Contacts , - Director Stephen P. Backhus (202) 512-7101 Acting Associate Director Cynthia M. Fagnoni (202) 512-7202 Assistant Directors Michael Blair (Atlanta Office) Daniel Brier Irene Chu Bruce Layton James Linz George Poindexter Paul Reynolds Page 7 ,’ 2 Ordering Information The first copy of each GAO report and testimony is free. Additional copies are $2 each. Orders should be sent to the following address, accompanied by a check or money order made out to the Superintendent of Documents, when necessary. VISA and Mastercard credit cards are accepted, also. Orders for 100 or more copies to be mailed to a single address are discounted 25 percent. Orders by mail: U.S. General Accounting Office P.O. Box 37050 Washington, DC 20013 or visit: Room 1100 700 4th St. NW (corner of 4th and G Sts. NW) U.S. General Accounting Office Washington, DC Orders may also be placed by calling (202) 512-6000 or by using fax number (202) 512-6061, or TDD (202) 512-2537. 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Veterans' Affairs and Military Health Care Issues Issue Area Plan--Fiscal Years 1998-99
Published by the Government Accountability Office on 1997-09-01.
Below is a raw (and likely hideous) rendition of the original report. (PDF)