VAOIG of Northern Arizona VA

Combined Assessment Program Review of the Northern Arizona VA Health Care System Prescott, Arizona 02/05/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 266 system employees. The review covered eight operational activities. The system complied with selected standards in the following five activities: (1) coordination of care, (2) pharmacy operations and controlled substances inspections, (3) QM, (4) staffing, and (5) survey of healthcare experiences of patients. We identified the system’s professional practice evaluation as an organizational strength. We made recommendations for improvement in the following three activities: (1) medication management, (2) environment of care, and (3) emergency/urgent care operations. VAOIG

Shinseki Works to Reduce Claims Backlog

VA Secretary Shinseki Working To Reduce Claims Backlog, Calls for 'Timely' Budget 02/05/09. In his first testimony before the House Committee on Veterans' Affairs on Wednesday, Department of Veterans Affairs Secretary Eric Shinseki said that he is working to reduce the six-month delay in paying veterans' disability claims and wants to move quickly in adopting an all-electronic claims system, the AP/Kansas City Star reports. KaiserNetwork.org

New Reports From the VAOIG

Combined Assessment Program Review of the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 02/04/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 627 system employees. The review covered eight operational activities. The system complied with selected standards in the following four activities: (1) coordination of care, (2) emergency/urgent care operations, (3) staffing, and (4) survey of healthcare experiences of patients. We identified transforming care at the bedside as an organizational strength. We made recommendations for improvement in the following four activities: (1) environment of care, (2) pharmacy operations and controlled substances inspections, (3) QM, and (4) medication management.

Combined Assessment Program Review of the VA Central Iowa Health Care System Des Moines, Iowa 02/03/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 88 employees. The review covered eight operational activities. The system complied with selected standards in the following two activities (1) staffing and (2) survey of healthcare experiences of patients. We identified the telepharmacy program and QM program redesign as organizational strengths. We made recommendations for improvement in the QM program, environment of care, coordination of care, pharmacy operations, medication management, and emergency/urgent care operations.

Review of Allegations of Mismanagement, Central Alabama Veterans Health Care System 02/03/09. In response to correspondence from the Chairman, Senate Committee on Veterans Affairs and the Chairman, House Committee on Veterans Affairs,the Office of Inspector General referred eight allegations of mismanagement at the Central Alabama Health Care System to the Director, Veterans Integrated Systems Network 7 (VISN) for a response. The VISN did not substantiate three of the allegation and the conclusions were supported by the documentation provided. The VISN partially substantiated three of the allegations and took corrective action, which included issuing a bills of collection to Emergency Room nurses who were paid at the wrong rate and to a physician who was inappropriately paid a retention bonus. The remaining two allegations involved contracts awarded to purchase the services of two retired VA employees. Although the VISN did not substantiate the allegations, based on our review of the documentation, we concluded that both contracting actions violated Federal acquisition regulations. There was no justification for awarding these procurements without competition. The Statement of Work to procure the services of the Financial Manager was inadequate and the purchase order issued to procure the services for the Credentialing and Privileging office did not include a Statement of Work. The purchase order for the services of a Financial Manager was issued against a Federal Supply Schedule contract that was not authorized to sell the services requested. In addition, the services were personal services and the duties and responsibilities included inherently governmental functions. VA does not have authority to issue contracts for personal services and it is improper to contract for inherently governmental functions. The VISN Director concurred with our findings and recommendations and implemented a plan to take corrective action.

Healthcare Inspection Mammography, Cardiology, and Colonoscopy Management Jack C. Montgomery VA Medical Center Muskogee, Oklahoma 02/03/09. This review was done at the request of Senator James Inhofe to determine the validity of allegations regarding delays in mammography services, cardiology consult responses, and scheduling colonoscopy procedures at the Jack C. Montgomery VA Medical Center. We determined that in 2007 patients did not consistently receive mammograms in a timely manner, cardiology consultation requests were not always scheduled within the required timeframe, and waiting times for scheduling colonoscopies was generally excessive. We substantiated that a subject colonoscopy patient did not receive a screening colonoscopy as requested and that a diagnostic colonoscopy was not scheduled within 60 days. We could not substantiate or refute whether primary care providers were notified regarding the status of requests from the three services. Prior to our visit, management had already implemented initiatives to correct the issues regarding delays. However, management needed to discuss the subject patient colonoscopy concern with Regional Counsel to determine whether this case met disclosure requirements. Management and the Regional Counsel have since determined that the case did not require disclosure; we consider this case closed.

New From U.S. Medicine

Legislators: VA Document Shredding Erodes Public Confidence 02/03/09. Incidents of veterans’ documents being slated for shredding when they should not have been has further eroded the public’s confidence in the Department of Veterans Affairs (VA), legislators told VA offi cials last month. Legislators placed the blame on VA’s dependence on paper files in its benefi ts offices and the still spotty transition of information between VA and the Department of Defense (DoD), along with a lack of proper oversight in handling the shredding incidents.

2008 Year in Review—VHA Healthcare: Continuing in Quality, Prepared for Challenges 02/03/09. In 2009, Americans will see a new president, new policies and new realities. In these changing times, however, our nation’s veterans will be able to rely on the same consistent quality healthcare they have come to expect from the Department of Veterans Affairs (VA). At VA, it is our honor and privilege to serve the most deserving patients in the United States—those who have served and sacrificed for all Americans in our nation’s armed forces. The Veterans Health Administration (VHA) has more than 230,000 employees who serve more than 1 million patients a week across the nation.

New VA Assistant Secretary Named

Duckworth Tapped for VA Assistant Secretary 02/03/09. President Barack Obama has announced his intent to nominate L. Tammy Duckworth, director of the Illinois Department of Veterans Affairs, to be the Assistant Secretary of Public and Intergovernmental Affairs for the Department of Veterans Affairs. VA

Brain Chemistry & PTSD

Brain Chemistry Plays Important Role in PTSD 0/01/09. The complex emotional and mental systems that have put humans at the top of the food chain can be a detriment when dealing with extreme stress, Dr. Southwick noted. “Animals rarely experience damage from their own stress response, because animals can turn off their stress response,” he explained. “Humans can become stressed from ideas, from perceptions, thoughts and emotions. This rumination can activate the stress response. And when can this stress response cause the most damage? When the stress is unremitting.” U.S. Medicine

Information Sharing Between VA and DoD.

VA and DoD Still Working on Information Sharing 0/01/09. A group of officials from the Department of Defense (DoD) and Department of Veterans Affairs (VA) said that progress is being made in sharing electronic health information between the two departments and that they are on track to meet the requirements of the National Defense Authorization Act of 2008 that directs them to have their electronic health record capabilities and systems fully interoperable by Sept. 30, 2009. U.S. Medicine

Suicide Rate Increase in Warfighters

Suicide Rate Among Army, Army Reserve, National Guard Reaches 28-Year High 01/30/09. The suicide rate among U.S. soldiers in 2008 rose to its highest rate since record-keeping began in 1980, the Army announced on Thursday, USA Today reports (USA Today, 1/29). At least 128 soldiers in the Army, Army Reserve and National Guard committed suicide in 2008. Army officials said that 15 deaths are still being investigated and the majority likely will be ruled suicide (Alvarez, New York Times, 1/30). KaiserNetwork.org

TSGLI Approval Rate for TBI

Traumatic Brain Injury: Better DOD and VA Oversight Can Help Ensure More Accurate, Consistent, and Timely Decisions for the Traumatic Injury Insurance Program 01/30/09. Although VA data show that 63 percent of service members with traumatic brain injury were approved for TSGLI, the actual approval rate may be lower, and DOD and VA lack assurance that claim decisions are accurate, consistent, and timely within and across the branches of service. VA’s data show that 520 of the 821 service members who filed TSGLI claims for traumatic brain injury received benefits. However, the actual approval rate may be lower because VA does not include all denials for traumatic brain injury in its data. In addition, DOD and VA officials told us there is no systematic quality assurance review process to ensure that claim decisions are accurate and consistent within and across the services. Finally, DOD and VA lack reliable data on how long it takes the services to make decisions on traumatic brain injury claims. GAO

VAOIG Inspection of Temple, Texas VA

Healthcare Inspection Allegations of Mental Health Diagnosis Irregularities at the Olin E. Teague VA Medical Center Temple, Texas 01/30/09. OIG reviewed allegations regarding a March 20, 2008, e-mail written by a staff psychologist of the Central Texas VA Healthcare System (CTVAHCS). This e-mail to colleagues was obtained by local and national media; it was widely disseminated and was the subject of a June 4, 2008, Senate Veterans’ Affairs Committee hearing. The e-mail was broadly interpreted as advocating that for veterans being seen by the post-traumatic stress disorder (PTSD) Clinical Team (PCT), a diagnosis of “adjustment disorder” be made over other psychiatric diagnoses, particularly PTSD. The e-mail also raised related issues regarding VA’s diagnosis, treatment, and compensation of veterans with mental health conditions such as PTSD. The e-mail message which prompted this review was an interoffice communication to clinic staff. Our interviews with all recipients of the message revealed no consistent perception that inappropriate diagnoses should be rendered. The e-mail was written on the author’s initiative, without direct or indirect instruction from local, regional, or national VA leadership. PCT clinic patient encounters were coded as adjustment disorders at similar rates before and after the e-mail message. For both PCT clinic and compensation and pension examination diagnoses and service-connection determinations, we observed no pattern in temporal relation to the e-mail. There was no discernible change in the appropriateness of diagnoses occurring before and after the e-mail. We made no recommendations. VAOIG

Advance Funding Legislation for VA

Akaka signals intention to reintroduce advance funding legislation 01/30/09. U.S. Senator Daniel K. Akaka (D-HI), Chairman of the Veterans' Affairs Committee, gathered six top national veterans' service organizations at a hearing to discuss their priorities for the new Congress. Committee members and the witnesses from the veterans' groups discussed a number of important issues facing America's veterans, from the backlog on benefits claims to timely implementation of the new GI Bill. The witnesses were unanimous in their support for legislation to fund veterans' health care one-year ahead of the regular appropriations process, as provided for in the Veterans Health Care Budget Reform Act of 2008, introduced by Chairman Akaka with bipartisan support in the previous Congress. Senate Committee on Veterans' Affairs

Reversing Paralysis

Stem cells used to reverse paralysis in animals 01/28/09. A new study has found that transplantation of stem cells from the lining of the spinal cord, called ependymal stem cells, reverses paralysis associated with spinal cord injuries in laboratory tests. The findings show that the population of these cells after spinal cord injury was many times greater than comparable cells from healthy animal subjects. Wiley-Blackwell via Eurekalert!

Lack of Means to Measure Interoperable Capabilities Between DoD and VA EHR

Electronic Health Records: DOD's and VA's Sharing of Information Could Benefit from Improved Management. 01/28/09. DOD and VA continue to increase health information sharing through ongoing initiatives and related activities. ...However, neither plan identifies results-oriented (i.e., objective, quantifiable, and measurable) performance goals and measures that are characteristic of effective planning and can be used as a basis to track and assess progress toward the delivery of new interoperable capabilities. In the absence of results-oriented goals and performance measures, the departments are not positioned to adequately assess progress toward increasing interoperability. GAO

Veteran Training in Digital Forensics

Walter Reed Army Medical Center Begins Partnership with Mississippi State University to Train Veterans in Digital Forensics 01/26/09. Computer science professors at Mississippi State University will train “wounded warriors” in digital forensics at Walter Reed Army Hospital in Washington D.C., to help improve job opportunities for them after leaving the military. Mississippi State University via Newswise

Assessment of VA Vocational Rehab Programs

VA Vocational Rehabilitation and Employment: Better Incentives, Workforce Planning, and Performance Reporting Could Improve Program. 01/6/09. By launching the Five-Track Employment Process, VR&E has strengthened its focus on employment, but program incentives have not been updated to reflect this emphasis. VR&E has delineated its services into five tracks to accommodate the different needs of veterans, such as those who need immediate employment as opposed to those who need training to meet their career goal. However, program incentives remain directed toward education and training. Veterans who receive those services collect an allowance, but those who opt exclusively for employment services do not. While VR&E officials said they believed it would be helpful to better align incentives with the employment mission, they have not yet taken steps to address this issue. GAO