As directed under the MISSION Act, VA created clinical resource hubs to improve healthcare access for veterans in underserved areas. The hubs backstop medical facilities in each regional Veterans Integrated Service Network (VISN) that do not have enough clinical staff due to attrition, recruiting difficulties, or growth in the veteran population. Hub physicians see most patients virtually. Encounters increased from almost 482,000 in fiscal year (FY) 2021 to about 1.2 million in FY 2024.
The OIG team found that despite the increase in patient encounters, physicians in some hub primary care and specialty group practices—such as cardiologists, dermatologists, and psychiatrists and psychologists—generally did not appear to meet established minimum productivity thresholds. The apparent failure to meet these thresholds may have been caused by gaps and inaccuracies in the data used to measure productivity. The available data did not consistently give physicians credit for work documented at a spoke site (where a veteran presents for care), recognizing only work documented at the facility to which the hub physician’s labor is mapped. Moreover, VHA lacked formal guidance on how hubs should measure and monitor specialty physician productivity. Hub officials simply relied on indicators like the number of patient encounters and veterans served, instead of using standardized productivity metrics that factor in the complexity of each visit. The lack of guidance also prevented VHA from identifying and remediating underperforming hub services.
The OIG recommended VHA improve data, issue guidance on which productivity measures apply to hub physicians, and clarify who should monitor productivity and take corrective action when targets are not met. These steps will help VHA evaluate whether the ever-increasing investment in hubs is justified and the number of veterans served is optimized. VHA agreed with the recommendations.
Open Recommendations
| Recommendation Number | Significant Recommendation | Recommended Questioned Costs | Recommended Funds for Better Use | Additional Details | |
|---|---|---|---|---|---|
| 01 | No | $0 | $0 | ||
| OIG recommends the under secretary for health implement procedures to monitor the data used to measure productivity to ensure the data accurately reflect the complete work of clinical resource hub physicians. | |||||
| 02 | No | $0 | $0 | ||
| OIG recommends the under secretary for health work with appropriate officials, such as Office of Primary Care and clinical resource hub leaders, to determine whether hub physicians should be subject to existing productivity measures. If so, issue clear hubs guidance requiring adherence; if not, clearly define what should be used, and issue thorough guidance on the steps hubs must take to measure physician productivity consistently. | |||||
| 03 | No | $0 | $0 | ||
| OIG recommends the under secretary for health clarify oversight responsibilities for monitoring productivity measures, including detailed procedures and actions that should be taken when thresholds are not met. | |||||
