Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Cincinnati VA Medical Center and multiple outpatient clinics in Kentucky, Indiana, and Ohio. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.Three of the medical center’s four executive leadership positions were occupied by acting staff. The Associate Director, the only permanently assigned leader, had been in the position for less than one year at the time of the OIG virtual review. Survey results revealed opportunities for the acting Chief of Staff to improve employee attitudes toward the workplace. Survey data also indicated that patients were generally satisfied with the care provided. However, gender-specific results highlighted opportunities to improve experiences in the inpatient and patient-centered medical home settings. The OIG identified concerns related to the identification of sentinel events and institutional disclosures. Leaders were knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and actions taken during the previous 12 months to maintain and improve performance.The OIG issued 16 recommendations for improvement in five areas:(1) Quality, Safety, and Value• Committee processes• Peer review processes• Root cause analyses(2) Medical Staff Privileging• Professional practice evaluations• Provider exit reviews(3) Mental Health• Suicide safety plans(4) Women’s Health• Designated women’s health providers• Women veterans health committee membership(5) High-Risk Processes• Standard operating procedures• CensiTrac® instrument tracking system• Eyewash station testing• Staff training

Our objective was to determine mailer compliance with Negotiated Service Agreement (NSA) provisions and evaluate the Postal Service’s oversight of NSA Contract [redacted]. We selected the NSA based on the mailer’s fiscal years (FY) 2019 and 2020 volume and revenue.

What We Looked AtThe Airline Deregulation Act of 1978 (ADA) gave airlines the freedom to determine which markets to serve and what fares to charge. However, it also raised concerns that communities with relatively low traffic levels might lose service entirely if carriers shifted their operations to larger, potentially more lucrative markets. Through the Essential Air Service (EAS) Program, the Department of Transportation (DOT) determines the requirements for each eligible community and subsidizes air carriers when necessary. In 2018, Congress directed our office to determine whether DOT was providing sufficient oversight of the unsubsidized air carriers providing basic essential air service. Accordingly, our objectives were to evaluate whether DOT (1) appropriately relied on unsubsidized air carriers for small communities and (2) conducted oversight of the services provided by those air carriers. What We FoundDOT appropriately relied on unsubsidized air carriers in accordance with its policy. Specifically, if an air carrier proposed to provide air service without a subsidy and the Department determined the carrier could reliably do so, DOT relied on the carrier’s service as proposed. Federal law does not require DOT to consider community views when it relies on unsubsidized carriers, and the Department did not prescribe specific content for their proposals. We also found that DOT conducted limited oversight of the EAS communities served by unsubsidized carriers. Federal law requires eligible communities to be provided with basic essential air service and air carriers to file a 90-day notice of their intent to end, suspend, or reduce such service. While unsubsidized carriers typically met the minimum departure criteria for their communities, officials in seven of the nine communities we reviewed were unaware that they could petition Department when issues arose. DOT also did not conduct required periodic reviews of the designated levels of service in unsubsidized communities, which limited its awareness of their essential air service needs. Our RecommendationsWe made two recommendations to improve DOT’s oversight of EAS communities served by unsubsidized carriers. The Department concurred with recommendation 1 and partially concurred with recommendation 2, which we consider to be open and unresolved pending a decision from DOT.