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 Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri and multiple outpatient clinics. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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. The executive leadership team had worked together for two months prior to the OIG visit. Survey results revealed that employees were generally satisfied with executive leaders. Patient experience survey data, including both male and female satisfaction scores, indicated that patients were generally satisfied with their care. The OIG’s review of the system’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. In addition, the executive leaders were knowledgeable within their scope of responsibilities about VHA data used by the Strategic Analytics for Improvement and Learning models. The OIG issued 14 recommendations for improvement across seven areas: (1) Quality, Safety, and Value • Utilization management processes • Root cause analysis processes (2) Medical Staff Privileging • Ongoing professional practice evaluations • Provider exit review forms (3) Medication Management • Behavior risk assessment • Urine drug testing • Informed consent • Follow-up after therapy initiation (4) Mental Health • Annual suicide prevention training (5) Care Coordination • Life sustaining treatment decisions progress notes • Multidisciplinary committee establishment (6) Women’s Health • Advisory Committee For Women Veterans membership (7) High-Risk Processes • Staff competency assessments

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 John J. Pershing VA Medical Center, Poplar Bluff, Missouri. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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. The executive team had been working together as a group for two months, although several team members had been in their positions for more than a year. Employee satisfaction survey results revealed opportunities for the Associate Director for Patient Care Services and Associate Director to decrease staff’s feelings of moral distress in the workplace. Patients appeared satisfied with their care. The OIG did not identify any substantial organizational risk factors. The leaders were knowledgeable about Strategic Analytics for Improvement and Learning data and should continue to take actions to sustain and improve performance. The OIG issued 17 recommendations for improvement across six areas: (1) Quality, Safety, and Value • Utilization management data review (2) Medical Staff Privileging • Focused professional practice evaluations • Provider exit review forms (3) Medication Management • Aberrant behavior risk assessments • Concurrent therapy with benzodiazepines • Urine drug testing • Informed consent • Follow-up after therapy initiation • Pain Management Sub-Committee activities (4) Mental Health • Follow-up visits • Suicide prevention training (5) Women’s Health • Women’s health primary care providers • Women Veterans Health Committee membership (6) High-Risk Processes • Standard operating procedures • Annual risk analysis • Staff competency assessments

With certain exceptions, self-administered drugs are typically not covered under Medicare Part B. However, in a November 2017 report, OIG found that CMS and a Federal court interpret relevant statute to require the inclusion of versions of drugs not generally covered under Part B in limited circumstances when setting Medicare payment amounts. As a result, CMS included noncovered, self-administered versions of Orencia and Cimzia when determining payments for those two drugs. The inclusion of these noncovered versions caused Medicare and its beneficiaries to pay an extra $366 million from 2014 through 2016. OIG recommended that CMS seek a legislative change that would provide the agency with flexibility to determine when noncovered versions of a drug should be included in the calculation of the Part B payment amount. CMS did not concur with our recommendation and, to date, no action has been taken to close the payment loophole.

The Office of the Inspector General determined that the Tennessee Valley Authority's (TVA) implementation of a grid access charge was revenue neutral because it resulted in an immaterial change in revenue to TVA. We determined TVA collected about $2 million less in revenue from the local power companies that implemented the grid access charge in fiscal year 2019.