Federal Reports

The Veterans Health Administration (VHA) uses staffing data to assess whether medical facilities have the necessary resources to manage community care needs. Accurate staffing data are critical for decision-making and funding allocation to support veterans’ access to community care. The VA Office of Inspector General (OIG) assessed whether medical facility leaders identified, authorized, recruited, and retained nurses and medical support assistants (MSAs) to meet increased demand for community care. The OIG found that VHA does not have reliable data or sufficient tools to assess community care staffing levels and needs at the network or national level. Facility leaders do not use consistent organizational codes to identify community care staff across VA medical facilities. Additionally, VA’s staffing assessment tool relies on self-reported data that are not effectively verified. Due to data entry errors and a lack of consistent validation or quality review, VHA included inaccurate information in congressionally mandated reports. Despite these limitations, facility community care leaders generally identified local staffing needs, and their resource management committees authorized the requested staff. Although most facilities could adequately recruit and retain community care nurses, many could not recruit and retain MSAs. To compensate for the lack of MSAs, some facilities used innovative strategies such as hiring incentives or consolidated community care units to help process community care referrals. The under secretary for health concurred or concurred in principle with the OIG’s five recommendations to improve the reliability of community care staffing data and recruitment and retention of MSAs.

This report provides information on 610,219 Disability Insurance (DI) beneficiaries whose claims were approved at the initial claim level by various state disability determination services (DDS) during Calendar Years (CY) 2020 and 2021. In each case, disability examiners (1) determined the beneficiaries had disabling conditions that were permanent and that medical improvement was not expected, and (2) established a 7-year medical review diary. As of December 22, 2022, SSA had terminated the DI benefit payment status of only 319 (.05 percent) beneficiaries after determining they were no longer disabled. However, SSA had terminated the payment status of 75,857 beneficiaries who died after SSA approved their claims, including 4,444 beneficiaries who died during the 5-month DI waiting period.

In response to a congressional request, the VA Office of Inspector General (OIG) inspected the John D. Dingell VA Medical Center in Detroit, Michigan (facility) to assess leaders’ progress toward implementation of recommendations from the VHA Office of the Medical Inspector (OMI). The OIG evaluated facility leaders’ actions related to High Reliability Organization (HRO) goals and Veterans Integrated Service Network (VISN) 10 leaders’ oversight of, and support provided to, the facility leaders.The OIG found concerns related to VISN and facility leaders’ corrective actions in response to 6 of the 10 OMI recommendations. (1) Facility leaders did not meet VHA requirements related to the supervision of post-graduate year -1 residents. (2) Facility leaders delayed taking a privileging action and missed opportunities for state licensing board (SLB) reporting. (3) The interim chief of surgery’s facilitation of morbidity and mortality (M&M) conferences was inconsistent. (4) The facility corrective action plan was deficient for the OMI recommendation regarding the reassessment of a Peer Review Committee member. (5) The VISN academic affiliations officer was not made aware of the OMI recommendation related to resident supervision, did not provide oversight to the facility’s surgical residency program, and did not ensure compliance with VHA policy. (6) The VISN surgical workgroup did not document vital information from the facility, which could have ramifications across other VISN facilities.The OIG identified additional concerns regarding stable and continuous leadership in the facility, the impact of leaders’ actions on HRO principles, and VISN oversight of, and support to, facility leaders. The OIG made four recommendations to VISN leaders and five recommendations to facility leaders. Recommendations addressed resident supervision, National Surgery Office review, National Practitioner Data Bank and SLB reporting, M&M conferences, VISN academic affiliations officer roles and responsibilities, VISN surgical workgroup, VISN oversight and support to the facility, and continued efforts towards HRO.