World Trade Center Health Program: Quality Assurance Program Should Include Monitoring of Access to Health Services
Fast Facts
The World Trade Center Health Program provides health services to eligible responders and survivors for conditions related to the Sept. 11 attacks.
Timely access is an important part of quality health care, but people have reported delays accessing program services outside the New York City area. We reviewed whether the program assesses the timeliness of access to these services.
The program's quality assurance committee is responsible for monitoring program activities. But it hasn't assessed this issue, in part because the program has not made timely access an explicit strategic priority—which we recommended addressing.
Highlights
What GAO Found
The World Trade Center Health Program, administered by the National Institute for Occupational Safety and Health (NIOSH), provides health services to eligible responders and survivors of the September 11, 2001, attacks at no cost. NIOSH contracts with clinics in the New York City area and a Nationwide Provider Network (NPN) to provide health services to these individuals—known as members. Spending on health services by the program increased by about 85 percent from fiscal year 2016 through 2021. (See figure.) Clinics that serve responders in the New York City area accounted for the majority of health services spending. Clinics that serve survivors in the New York City area and through the NPN accounted for a growing share of total spending over the time period reviewed.
World Trade Center Health Program Spending on Health Services, Fiscal Years 2016 through 2021
The World Trade Center Health Program Quality Assurance Committee is comprised of senior program leadership. It was established to develop quality assurance objectives, formulate plans to achieve those objectives, and monitor related activities throughout the program. This is to be accomplished, for example, by recommending the development of performance metrics. In addition, NIOSH developed strategic priorities for the program. According to officials, NIOSH also applies resources, including quality assurance staff, to support these priorities.
Timely access to health services is an important component of quality health care. However, NIOSH has not specified ensuring timely access among the program's strategic priorities. In addition, the Quality Assurance Committee has not assessed the extent to which members have timely access to health services through the NPN because there are no quality assurance metrics for this. However, information previously collected by the NPN contractor, which was not provided to the Quality Assurance Committee, indicates there were potential problems with the timeliness of members' access to health services. Absent prioritizing timely access to health services, establishing metrics, and reviewing metric data, there is increased risk that reported delays in some members' access to NPN-provided health services may continue and negatively affect those members' morbidity, mortality, and quality of life.
Why GAO Did This Study
The World Trade Center Health Program provides health services, such as monitoring and treatment for conditions related to the September 11, 2001, attacks, through clinics in the New York City area and the NPN. The program is required to ensure reasonable access to health services through the NPN. However, program stakeholders have reported delays with members' access to these services.
The James Zadroga 9/11 Health and Compensation Reauthorization Act included a provision for GAO to review the World Trade Center Health Program. This report examines the extent to which (1) program spending on health services increased, and (2) NIOSH's quality assurance efforts included assessing the timeliness of access to health services for members through the NPN. GAO analyzed data on claims paid by the program. GAO also interviewed NIOSH officials and reviewed program documents on its quality assurance governance structure and strategic priorities.
Recommendations
GAO is making three recommendations to NIOSH: (1) add ensuring timely access to health services as a program strategic priority, (2) establish metrics for assessing the timeliness of access to health services through the NPN, and (3) ensure that the Quality Assurance Committee review metric data. The agency concurred with our recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| National Institute for Occupational Safety and Health | The Director of NIOSH should update the WTCHP Quality Assurance Plan's strategic priorities to include ensuring timely access to the five types of WTCHP health services and update program activities to align with this priority. (Recommendation 1) |
World Trade Center Health Program (WTHCP) officials have updated the Quality Assurance Plan's strategic priorities to include timely access to WTCHP health services. Specifically, in January 2023, HHS stated that the agency had hired a consultant group to assist with the Program's annual strategic planning. According to HHS, WTCHP leadership provided the consultant group with our recommendation language, was planning to hold a strategic planning summit with the consultant group in February 2023, and would finalize the Program's strategic plan in the following months-inclusive of a strategic priority on ensuring timely access to WTCHP health services. Subsequently, in January 2024, HHS provided a copy of the March 2023 version of the strategic plan that included a goal to "provide quality and timely health care," under the strategic priority on "Excellence in Program Services." However, HHS still needs to indicate how the WTCHP will update program activities to align with this new goal to fully implement our recommendation.
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| National Institute for Occupational Safety and Health | The Director of NIOSH should establish quality assurance metrics related to the timeliness with which members can access WTCHP health services provided through the Nationwide Provider Network, and as appropriate the Clinical Centers of Excellence. Such metrics should account for the five types of WTCHP health services and include wait time standards and benchmarks. (Recommendation 2) |
As of January 2024, WTCHP officials have taken initial steps to develop quality assurance metrics on members' timely access to WTCHP health services. HHS indicated that WTCHP officials had assessed other federal payer approaches to measuring wait times and was collaborating with the Nationwide Provider Network (NPN) and Clinical Centers of Excellence (CCE) to identify a suitable approach for the program. Specifically, HHS stated that WTCHP officials sent the NPN and CCEs a questionnaire in the summer of 2023 to assess how the clinics facilitate timely access to care for members, to understand how the clinics track appointment availability and identify issues with such timely access. As a result, HHS stated that WTCHP officials are exploring how to unify the clinics' different processes. GAO encouraged these officials to continue to develop wait time metrics as well as a standardized approach for the NPN and CCEs to collect and report related data, which will be needed to fully implement our recommendation.
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| National Institute for Occupational Safety and Health | The Director of NIOSH should ensure that the WTCHP Quality Assurance Committee review data on the timeliness with which members can access WTCHP health services provided through the Nationwide Provider Network, and as appropriate the Clinical Centers of Excellence, on at least an annual basis to identify and take steps to address any needed improvements. At a minimum, this should include reviewing the data on the quality assurance metrics related to access to care for the five types of WTCHP health services after they are established. (Recommendation 3) |
In January 2023 and January 2024, HHS shared information on the WTCHP Quality Assurance Committee's role in the development of quality assurance metrics on members' timely access to the five types of WTCHP health services. Specifically, the committee met in August 2022 to begin discussing potential metrics. During the June 2023 Quality Assurance Committee meeting, staff from the program's Quality Management & Program Evaluation Unit provided an update on the steps being taken to develop such metrics. According to HHS, the committee endorsed the planned next steps for developing metrics on timely access to health services. Additionally, in January 2024, HHS shared a committee meeting agenda template that includes a standing item on updates related to our recommendation. According to HHS, staff from the Quality Management & Program Evaluation Unit plan to use this to provide quarterly updates to the committee on activities related to assessing timely access to care. We will continue to track the program's actions to establish quality assurance metrics related to members' timely access to WTCHP health services, and then, once developed, the Quality Assurance Committee's actions to review the results of those metrics and take any needed actions.
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