GAO: VA clinical quality measures are flawed, data incomplete

Limitations in its data system prevent metrics from capturing all provider types and provider workload – among other technical and policy flaws.
By Jessica Davis
02:35 PM
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quality of care at VA hospitals

The U.S. Department of Veterans Affairs’ clinical quality measures are incomplete and provide an inaccurate reflection of clinical measures, according to a new report from the U.S. Government Accountability Office.

Data system limitations inhibit the metrics from capturing all provider types within the agency, which means data collected by the VA doesn’t account for all of its providers or clinical services, officials said. As a result, clinical workloads or staffing levels may not be accurately reflected.

Metrics also fail to capture provider workload for evaluating and managing hospitalized patients.

VA providers also fail to always accurately code the intensity of clinical services, which means productively metrics may not reflect provider productivity. Officials said the cause is the differences between provider coding inaccuracies, not variances in productivity.

In addition, the agency’s productivity metrics may not show actual clinical staffing levels, due to failure to accurately record the amount of time spent on clinical duties versus other tasks. As a result, officials said the VA’s utilization and expenditures might be inaccurate.

Officials said the VA Central Office has taken steps to address the issue with a comprehensive analytical tool that will help identify the cause of low productivity. However, at the moment, VA medical centers aren’t required to monitor VA efficiency models -- just its productivity metrics.

Further, the VA doesn’t systemically oversee its medical center efforts to monitor clinical productivity and efficiency, which means it can’t determine the factors contributing to low productivity and inefficiency.

“This approach is inconsistent with federal standard for internal control related to monitoring,” officials said.

GAO recommended the VA expand current productivity metrics to track all providers; develop training to all providers on clinical coding procedures; require medical centers to monitor clinical efficiency through a standard process; and establish an ongoing proactive to systemically review remediation plans.

VA concurred with all recommends and explained its plans for implementation to GAO.

VA Secretary Shulkin is determined to modernize the agency, which includes an overhaul of current standards and IT systems. He recently announced the agency will transition its outdated VistA EHR system to Cerner.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com


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