In 2007, following reports of poor case management for out-patients at Walter Reed Army Medical Center, the DoD and the VA jointly developed the Fed. Recovery Coordination Program (FRCP) to coordinate the clinical and non-clinical services needed by severely wounded, ill, and injured service-members and veterans. The FRCP is administered by the VA, and the care coordinators, called Fed. Recovery Coordinators (FRC), are VA employees. This report examines: (1) whether service-members and veterans who need FRCP services are being identified and enrolled in the program; (2) staffing challenges confronting the FRCP; and (3) challenges facing the FRCP in its efforts to coordinate care for enrollees. Illus. A print on demand report.
The VA estimates it will provide health care to 5.8 million patients with appropriations of about $41 billion in FY 2009. It provides a range of services, including primary care, outpatient and inpatient services, long-term care, and prescription drugs. VA formulates its health care budget by developing annual estimates of its likely spending for all its health care programs and services, and includes these estimates in its annual congressional budget justification for VA health care. This testimony addresses: (1) challenges VA faces in formulating its health care budget; and (2) issues surrounding the possibility of providing advance appropriations for VA health care. Illustrations.
Funding for VA health care is determined by Congress in the annual appropriations process. Prior to this process, VA develops a budget estimate of the resources needed to provide health care services to eligible veterans. The Veterans Health Care Budget Reform and Transparency Act of 2009 requires an assessment of whether the funding requested for VA health care in the President's budget requests submitted to Congress in 2011, 2012, and 2013 is consistent with VA's estimates of the resources needed to provide health care services. This report describes: (1) how the VA develops its health care budget estimate; and (2) how VA's health care budget estimate is used in the President's budget request to Congress. Illus. A print on demand report.
In addition to providing health care to over 5 million vets each year, the Vets Health Admin. funds research on specific health conditions that veterans may experience. One such condition is is post-traumatic stress disorder (PTSD), an anxiety disorder that can occur after a person is exposed to a life-threatening event. Up to 30% of Vietnam vets and up to 20% of Oper. Enduring Freedom vets and Oper. Iraqi Freedom vets have experienced PTSD. In 2001, VA awarded a contract to conduct a follow-up study, the NVVLS. However, in 2003, VA terminated the contract and the study was not completed. This report discusses: (1) the recent progress VA has made in conducting the NVVLS; and (2) the challenges VA faces in its plans to conduct the NVVLS. Illus.
The Nat. Defense Authorization Act for FY 2008 (NDAA 2008) requires DoD and VA to jointly develop and implement comprehensive policies on the care, mgmt., and transition of recovering servicemembers. The Senior Oversight Committee has assumed responsibility for these policies. The NDAA 2008 requires a report on the progress DoD and VA make in developing and implementing the policies. This statement provides preliminary info. on: (1) the progress DoD and VA have made in jointly developing the comprehensive policies required in the NDAA 2008; and (2) the challenges DoD and VA are encountering in the joint development and initial implementation of these policies. Illustrations. This is a print on demand report.
At the DoD, a personality disorder can render a servicemember unsuitable for service. This is a report on personality disorder separations and it examines: (1) the extent that selected military installations complied with DoD's separation requirements; and (2) how DoD ensures compliance with these requirements. The auditor reviewed a sample of 312 servicemembers' records from four installations, representing the Army, Air Force, and Marine Corps, that had the highest or second highest number of Operation Enduring Freedom or Operation Iraqi Freedom servicemembers separated because of a personality disorder. Includes recommendations. Charts and tables.
The Dept. of Veterans Affairs (VA) estimates it will provide health care to 5.8 million patients with appropriations of $41.2 billion in FY 2009. The President has proposed an increase in VA's health care budget for FY 2010 to expand services for veterans. VA's patient population includes aging veterans who need services such as long-term care -- including nursing home and non-institutional care provided in veterans' homes or community -- and veterans returning from Afghanistan and Iraq. This testimony discuss challenges related to VA's health care services budget formulation and execution, and focuses on: (1) challenges VA faces in formulating its health care budget; and (2) challenges VA faces in executing its health care budget.
The National Defense Authorization Act for FY 2008 (NDAA 2008) requires the DoD and Veterans Affairs (VA) to jointly develop and implement comprehensive policies on the care, management, and transition of recovering servicemembers. The NDAA 2008 also requires a report on the progress DoD and VA make in jointly developing and implementing the policies. This report focuses on the joint development of the policies. Specifically, it provides information on: (1) the progress DoD and VA have made in jointly developing the comprehensive policies required by the NDAA 2008; and (2) the challenges DoD and VA are encountering in the joint development of these policies. Charts and tables.
During recent work on services available for women veterans, several clinicians expressed concern about the physical safety of women housed in mental health programs at a Department of Veterans Affairs (VA) medical facility. This testimony discusses an examination of: (1) the volume of sexual assault incidents reported in recent years and the extent to which these incidents are fully reported; (2) what factors may contribute to any observed underreporting; and (3) precautions VA facilities take to prevent sexual assaults and other safety incidents. Charts and tables. This is a print on demand edition of an important, hard-to-find publication.
The Department of Veterans Affairs (VA) clinicians use expendable medical supplies ¿ disposable items that are generally used one time ¿ and reusable medical equipment (RME), which is designed to be reused for multiple patients. VA has policies that VA medical centers (VAMC) must follow when purchasing such supplies and equipment, tracking these items at VAMCs, and reprocessing ¿ that is, cleaning, disinfecting, and sterilizing ¿ RME. This report evaluates: (1) purchasing, tracking, and reprocessing requirements in VA policies; and (2) VA¿s oversight of VAMCs¿ compliance with these requirements. Includes recommendations. Charts amd tables. This is a print on demand edition of an important, hard-to-find publication.
In FY 2007, the Dept. of Veterans Affairs (VA) spent $4.1 billion on long-term care for veterans. VA provides -- through VA or other providers -- institutional care in nursing homes and non-institutional care in veterans' homes or the community. In 2007, the VA published a long-term care strategic plan through FY 2013. These estimates are based on workload projections -- the amount of care to be provided -- and cost assumptions. This report examined: (1) VA's reporting of planned workload in its 2007 long-term care strategic plan; and (2) VA's long-term care spending estimates, including its cost assumptions and workload projections, in VA's FY 2009 budget justification. Includes recommendations. Charts and tables.
Historically, the vast majority of Vet. Admin. (VA) patients have been men, but that is changing. VA provided health care to over 281,000 women veterans (WV) in 2008 -- an increase of about 12% since 2006. WV seeking care at VA medical facilities need access to a full range of health care services, incl. basic and specialized gender-specific services -- such as cervical cancer screening and treatment of reproductive cancers. This testimony discusses: (1) the on-site availability of health care services for WV at VA facilities; (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care services for WV; and (3) some key challenges that VA facilities are experiencing in providing health care services for WV. Illus.
In addition to providing health care to vets, the VA funds research that focuses on health conditions vets may experience. Experts estimate that up to 20% of Operation Enduring Freedom and Operation Iraqi Freedom vets have experienced PTSD and demand for PTSD treatment is increasing. This report examined VA¿s funding of PTSD research, and its processes for funding PTSD research proposals, reviewing and incorporating research outcomes into clinical practice guidelines -- tools that offer clinicians recommendations for clinical services but do not require clinicians to provide one service over another -- and determined which PTSD services are required to be made available at VA facilities. Charts and tables. This is a print on demand report.
VA officials and providers face challenges related to providing Substance Use Disorder (SUD) services to vets who have or are at risk for SUDs. This report discusses VA's efforts to address these challenges, which include: (1) Efforts to increase veterans' access to its SUD services -- VA is establishing additional intensive outpatient programs; (2) Efforts to promote the use of evidence-based SUD treatments -- VA is requiring facilities to make certain treatments, such as cognitive behavioral therapy for relapse prevention, available to vets; (3) Efforts to assess SUD services and monitor treatment effectiveness -- VA is assessing the progress that VA medical centers are making related to SUD services. Illustrations. This is a print on demand report.
The VA faces challenges in bridging language and cultural barriers as it seeks to provide quality health care services to an increasingly diverse vet. population in terms of race, ethnicity, sex, and age. To meet the needs of vets. with limited English proficiency (LEP), VA issued an Directive that provides guidance for medical centers in assessing language needs and, if needed, developing language access services. In addition, VA is also challenged to deliver health care services in ways that are culturally appropriate. This report discusses the: (1) actions VA has taken to implement its LEP Directive and the status of vets¿ utilization of language access services; and (2) efforts VA has made to provide culturally appropriate health care services.
Military servicemembers engaged in combat tours in Iraq and Afghanistan are at risk of developing post-traumatic stress disorder. In Mar. '05 the DoD developed policies for the post-deployment health reassessment (PDHRA). DoD oversees the military services¿ compliance with PDHRA requirements through its deployment health assessment quality assurance program (DHAQAP). In June 2007, it was reported that DoD¿s oversight of its DHAQAP does not provide DoD or Congress with the info. needed to evaluate DoD and the military services¿ compliance with DHAQAP. This report discusses how well DoD¿s DHAQAP oversees the military services¿ compliance with the requirement that they ensure that servicemembers complete the PDHRA. Ill.
The DoD implemented the post-deployment health reassessment (PDHRA), which is required to be administered to servicemembers 90 to 180 days after their return from deployment. DoD established the PDHRA program to identify and address servicemembers¿ health concerns that emerge over time following deployments. This report is the second in a review of DoD¿s admin. of the PDHRA. This report examined: (1) the extent to which DoD¿s central repository contains PDHRA questionnaires for active and Reserve component servicemembers who returned from deployment to Iraq or Afghanistan; and (2) how DoD monitors the admin. of the PDHRA to Reserve component servicemembers. Illustrations.
TRICARE Reserve Select (TRS) provides certain members of theSelected Reserve - reservists considered essential to wartimemissions - with the ability to purchase health care coverage under the Department of Defense's (DoD) TRICARE program after their active duty coverage expires. TRS is similar to TRICARE Standard, a fee-for-service option, and TRICARE Extra, a preferred provider option. This report examines: (1) how DoD ensures that members of the Selected Reserve are informed about TRS; and (2) how DoD monitors and evaluates access to civilian providers for TRS beneficiaries. Charts and tables. This is a print on demand edition of an important, hard-to-find report.
Improved Staffing Methods and Greater Availability of Alternate and Flexible Work Schedules Could Enhance the Recruitment and Retention of Inpatient Nurses
Improved Staffing Methods and Greater Availability of Alternate and Flexible Work Schedules Could Enhance the Recruitment and Retention of Inpatient Nurses
Registered nurses (RNs) are the largest group of health care providers employed by VA's health care system. RNs are relied on to deliver inpatient care, but VA medical centers (VAMC) face RN recruitment and retention challenges. VAMCs use a patient classification system (PCS) to determine RN staffing on inpatient units by classifying inpatients according to severity of illness to determine the amount of RN care needed. This report reviewed VAMC inpatient units for: (1) the usefulness of information generated by VA's PCS; (2) key factors that affect RN retention; and (3) factors that contribute to delays in hiring RNs. The auditor conducted RN focus groups at eight VAMCs. Includes recommendations. Charts and tables.
The Dept. of Defense (DOD) provides health care through its TRICARE program, which is managed by the TRICARE Management Activity (TMA). TRICARE offers three basic options. Beneficiaries who choose TRICARE Prime, an option that uses civilian provider networks, must enroll. TRICARE beneficiaries who do not enroll in this option may obtain care from nonnetwork providers under TRICARE Standard or from network providers under TRICARE Extra. This report examines (1) impediments to TRICARE Standard and Extra beneficiaries’ access to civilian health care and mental health care providers and TMA’s actions to address the impediments; (2) TMA’s efforts to monitor access to civilian providers for TRICARE Standard and Extra beneficiaries; (3) how TMA informs network and nonnetwork civilian providers about TRICARE Standard and Extra; and (4) how TMA informs TRICARE Standard and Extra beneficiaries about their options. Tables and figures. This is a print on demand report.
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCOE) was established to lead the Department of Defense¿s (DoD) effort to develop excellence in DoD prevention, outreach, and care for those with psychological health and traumatic brain injury conditions. This report examined: (1) challenges DCOE has faced in its development; (2) the extent to which DCOE's strategic plan aligns with key practices used by leading public-sector organizations; and (3) the extent to which internal controls provide reasonable assurance that DCOE information on financial obligations is reliable for management decision making. Includes recommendations. Charts and tables. This is a print on demand report.
In Feb. 2007, a series of Washington Post articles disclosed problems at Walter Reed Army Medical Center, particularly with the management of servicemembers receiving outpatient care. In response, the Army established Warrior Transition Units (WTU) for servicemembers requiring complex case management. Each servicemember in a WTU is assigned to a Triad of Care (ToC) -- a primary care manager, a nurse case manager, and a squad leader -- who provide case management services to ensure continuity of care. The Army established staff-to-servicemember ratios for each ToC position. This report examines: (1) the Army's ongoing efforts to staff WTU ToC positions; and (2) how the Army monitors the recovery process of WTU servicemembers. Illus.
This is a print on demand edition of a hard to find publication. In FY 2009, the VA provided more than 59 million prosthetic items to more than 2 million vets. After VA physicians prescribe prosthetic items, VA's Prosthetic and Sensory Aids Service (PSAS) is responsible for providing prosthetic items to vets. PSAS is also responsible for managing VA's spending for prosthetic items -- more than $1.6 billion in FY 2009. This report examined: (1) how, for FY 2005 through 2009, VA's spending for prosthetic items compared to budget estimates, and the extent to which VA reallocated funding for prosthetic items; (2) how PSAS monitors its performance in processing and providing prosthetic items to vets; and (3) the efforts VA has undertaken to improve PSAS's performance. Charts and tables.
The Coast Guard (CG) is in the final stages of planning the largest procurement project in its history -- the modernization &/or replacement of over 90 cutters and 200 aircraft used for missions beyond 50 miles from shore. This project, called the Deepwater Capability Replacement Project, is expected to cost over $10 billion and take 20+ years to complete. In 2001, the CG will be evaluating proposals now being developed by 3 contracting teams competing for a contract to build the deepwater system. The CG plans to award a contract to one of these teams early in 2002. This report monitors the project closely and provides info. for the Congress, as it considers funding for this project.
Media reports in 2005 and 2006 highlighted serious problems at organ transplant programs, calling attention to possible deficits in fed. oversight. Two agencies oversee organ transplant programs: the Centers for Medicare and Medicaid Services oversees transplant programs that receive Medicare reimbursement, and the Health Resources and Services Admin. oversees the Organ Procurement and Transplantation Network, which manages the nation's organ allocation system. This report examines: (1) fed. oversight of transplant programs at the time the high-profile cases came to light in 2005 and 2006; and (2) changes that fed. agencies have made or planned since then to strengthen oversight. Includes recommendations. Illustrations.
Over the course of five decades, John Williamson has published an extraordinary number of books, articles, and other pieces on topics ranging from international monetary economics to development policy and bridging scholarly literature and policy debates. This book provides an overview and insight into Williamson's work. It includes contributions from the editors, Stanley Fischer, Edwin M. Truman, Paul De Grauwe, Yuemei Ji, Marcus Miller, Avinash Persaud, Stephany Griffith-Jones, Dagmar Hertova, Olivier Jeanne, Shankar Acharya, Jose Antonio Ocampo, and an essay by John Williamson on designing economic policy.
The Veterans Health Care Budget Reform and Transparency Act of 2009 required this report on whether the amounts for the Dept. of Veterans Affairs' (VA) health care services in the President's budget request are consistent with VA's budget estimates as projected by the Enrollee Health Care Projection Model (EHCPM) and other methodologies. Based on the information VA provided, this report describes: (1) the key changes VA identified that were made to its budget estimate to develop the President's budget request for fiscal years 2012 and 2013; and (2) how various sources of funding for VA health care and other factors informed the President's budget request for fiscal years 2012 and 2013. Charts and tables. This is a print on demand reort.
The DoD provides health care and mental health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through TRICARE Prime, an option that includes the use of civilian provider networks and requires enrollment. TRICARE beneficiaries who do not enroll in this option may obtain care from non-network providers through TRICARE Standard, or from network providers through TRICARE Extra. Servicemembers who use TRICARE Standard, TRICARE Extra, or TRICARE Reserve Select are referred to as non-enrolled beneficiaries. This report analyzes the adequacy of DoD's surveys of TRICARE beneficiaries and providers and shows what the surveys' results indicate about access to care for non-enrolled beneficiaries. Illus.
Native Americans who have served in the military may be eligible for health care services from both the Veterans Administration (VA) and the Indian Health Service (IHS). To enhance health care access and the quality of care provided to Native American veterans, in 2010, these two agencies renewed and revised a memorandum of understanding (MOU) designed to improve their coordination and resource sharing related to serving these veterans. This report examined how the agencies have implemented the MOU. It discusses: (1) the extent to which the agencies have established mechanisms through which the MOU can be implemented and monitored; and (2) key challenges the agencies face in implementing the MOU and the progress made in overcoming them. Tables. This is a print on demand report.
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