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On orders from Congress, the Department of Veterans Affairs has been doing a detailed study of nearly 100 health care markets nationwide. It aims to realign facilities with where veterans actually are those results out on Monday. And now the Government Accountability Office has studied VA’s studies. And for what the auditor has found, the GAO’s Director of Health Care Issues Sharon Silas joined Federal Drive with Tom Temin.

Interview transcript:

Tom Temin: Sharon, good to have you back.

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Sharon Silas: Thanks for having me, Tom.

Tom Temin: And the GAO found some data problems with what VA is basing this entire set of recommendations on. What did you find?

Sharon Silas: So we conducted a review of VA’s market assessments. The 2018 MISSION Act required VA to do the systemwide review of the delivery of health care to veterans. And so what the VA was doing was looking at both the demand, current and projected demand for VA health care services, and also looking at the supply of health care services. So the capacity to provide care to veterans through the VA Health Care System and also through non-VA health care services. And so we took a look at the methodology that VA was using to conduct these assessments. And basically, we had two key findings in our report. As VA was looking at both the demand and the supply of veterans’ health care services, they had reviewed over 60 sources of data primarily based on VA databases. And they compiled data from these databases. We’re looking at both the demand and supply of health care within VA, and then also looking at the demand and the provision of health care service through their veterans Community Care Program, which is where veterans can receive care out in the community. And what we found was that there were some gaps in the data that was compiled. And specifically, we found that VA didn’t really fully account for the expanded eligibility requirements for Community Care in 2018. The MISSION Act also expanded the eligibility requirements, so you have many more veterans taking advantage of going to see a provider in their community. And really, VA only accounted for about four months of the Community Care Program with this newly expanded eligibility. And so we thought that they could have done some things to try to get more updated information or data about how many veterans were accessing community care. Another example of a gap in the data that we identified was that there was really a lack of data to compare costs of care, at least based on the documentation they provided us. When VA built a number of their facilities, their VA health care systems were really focused on inpatient care and kind of having enough beds in facilities. And really, VA has pivoted from focusing on inpatient care to outpatient care, like many health care systems. So when we looked at the methodology they we’re using, we found that there was a lack of data to compare costs of care. And specifically, we didn’t see any information on the cost of data for outpatient care, which seems really important if that’s kind of what you’re pivoting to.

Tom Temin: One of the other gaps that you found is that VA didn’t accurately assess whether in a given area the community care providers had the personnel capacity to deal with what might be the demand from VA.

Sharon Silas: That’s correct. One of the other concerns we had was incomplete data on the network adequacy or the Community Care Program. GAO has conducted a number of views on the Community Care Program. And there have been concerns raised about whether or not there are enough providers, especially around specialty care to meet veterans’ needs, and especially in rural communities.

Tom Temin: We’re speaking with Sharon Silas, she’s director of health care issues at the Government Accountability Office. And between the congressional mandate in 2018, and now we’ve of course had a pandemic which distorted everything connected with health care in the United States, do you think VA was affected by that? Does their tallies and databases take that into account? And could that have had some effect on the recommendations that came out Monday?

Sharon Silas: Of course, with a pandemic, there was a shift in how veterans are receiving that care. For example, there was an increase in veterans receiving care via telehealth. And so we did learn from VA that they did take a look and include it in their analysis. The VA’s emergency response to COVID-19 pandemic and took those things into consideration. But as you know, the pandemic is I guess, still ongoing or just ending right now. So there’s still I think, a lot of data and information that is more recent that can help inform some of the recommendations that they’re making to the commission.

Tom Temin: And that really gets to the big question, given the data gaps that you found and the fact that the pandemic has bent things to a way they may not have fully accounted for. Are they reliable do you think, these recommendations that the VA came out with? This is their deadline to get this out for Congress, but should they take another six months to re-run their analyses with the data gaps filled?

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Sharon Silas: One of the other things the MISSION Act did was that it requires that there be a presidentially-appointed commission that will review the recommendations that VA is making regarding realignment and modernization. And so that commission, the members were recently nominated last week, they will spend the next year reviewing the recommendations that VA has made, holding hearings and having discussions and kind of getting behind those recommendations to get a better understanding of how VA arrived at them. And we have another recommendation report, because we’ve had concerns about communicating any limitations around assessment. And so we’ve made a recommendation that VA ensure that as they’re presenting these recommendations to the commission that they also present any information around data reliability, or data quality issues, so that the commission has that information. So they have a good understanding of how VA has arrived at these recommendations and any limitations around those.

Tom Temin: This would be the Asset and Infrastructure Review (AIR) Commission, so to speak?

Sharon Silas: That’s correct.

Tom Temin: So then that could set up the issue of the AIR commission looking at these recommendations, but the recommendations and the data underlying them could change over that year’s time that they have to review it.

Sharon Silas: Yeah, and the assessment process and kind of the next year – well, as the commission is reviewing the recommendation – have all been set up to do that, right, to ensure that the recommendations that VA is supporting, that there is scrutiny over them. And hopefully, once you get behind where the recommendations and some of the data underlying it, it will build in some transparency and hopefully build in support for those recommendations.

Tom Temin: Right, because some of the recommendations could be drastic, a hospital could be closed, or a new one built somewhere else. And, of course, you’ve got the unions worried about whether this is all just a gambit to privatize VA, which I don’t think it is, but what I’m driving at is they have to have everyone have the perception that this was done objectively and with the proper and full data.

Sharon Silas: Exactly. And that’s why the two recommendations that we have in that report is to help to ensure that VA has the most complete information possible, because of course, there’s no perfect data, right? But have the most complete information possible, especially around the supply of health care, and what’s available in these communities. And then also making sure that they’re communicating the limitations of the underlying data to help ensure that there’s transparency and then build confidence in how, again, how VA arrived at these recommendations.

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Tom Temin: And does VA generally agree with what the GAO is recommending?

Sharon Silas: They did. They concurred with both of our recommendations and in their comments on our report, they kind of laid up their steps to make sure that they addressed those recommendations over the next year.

Tom Temin: Yeah, this is almost like the VA’s equivalent of BRAC, and no matter what recommend then, somebody is gonna be unhappy.

Sharon Silas: Yes, exactly.

Tom Temin: Life in the USA in the 21st century. Sharon Silas is director of Health Care Issues at the Government Accountability Office. As always, thanks so much.

Sharon Silas: Thanks so much, Tom.

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