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VA Health Care: Use of Private Providers Should Be Better Controlled

HRD-92-109 Published: Sep 28, 1992. Publicly Released: Sep 28, 1992.
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Highlights

Pursuant to a congressional request, GAO examined the Department of Veterans Affairs' (VA) controls for ensuring that it appropriately purchased private outpatient medical care.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should require the Chief Medical Director to clarify to medical centers that private care should only be purchased from private providers when the needed services are not available at VA facilities or the private providers can treat veterans considered geographically inaccessible more economically than VA facilities can treat them.
Closed – Implemented
In January 1995 VA issued guidelines that stated VA has authority to contract for private care only when: (1) medical services are not available at VA; or (2) VA is incapable of economically providing the required medical services due to geographic inaccessibility.
Department of Veterans Affairs The Secretary of Veterans Affairs should require the Chief Medical Director to provide medical centers with procedures, including implementing guidance, on how to develop cost comparisons for use in authorizing private care.
Closed – Implemented
The January 1995 guidelines require that a cost comparison be made when VA can provide the needed medical care or services, but VA is not capable of furnishing economical care or services due to geographical inaccessibility. The guidelines provide instructions on how such cost comparisons should be developed.
Department of Veterans Affairs The Secretary of Veterans Affairs should require the Chief Medical Director to ensure that all medical centers reevaluate the appropriateness of private care authorizations for all veterans currently authorized private care.
Closed – Implemented
The January 1995 guidelines require that the appropriateness of non-VA medical care authorizations for all veterans must be reevaluated. The guidelines spell out the types of analysis and documentation required for evaluations and reviews of appropriateness of private care. The evaluations and reviews must be completed before such care is authorized.
Department of Veterans Affairs The Secretary of Veterans Affairs should require the Chief Medical Director to develop and implement a process for monitoring centers' compliance with VA policies and procedures for use of private providers to treat veterans.
Closed – Not Implemented
VA developed a Fee-Basis Status Report, which provides information regarding the overall operation of facilities' fee-basis programs. But additional staffing is needed, according to VA, to review individual facilities' reports and to incorporate the review into site visits.

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Topics

Cost effectiveness analysisEligibility determinationsHealth care cost controlHealth services administrationHospital administrationMedical economic analysisMedical expense claimsPatient care servicesVeterans hospitalsVeterans