Federal Reports

The VA Office of Inspector General (OIG) examined whether the Veterans Health Administration (VHA) effectively used data from its National Surgery Office (NSO) to identify and address problems affecting operating room efficiency. The audit focused on four elements needed for efficient and timely surgeries: clinical service staff, sterile processing and logistics services, the environmental management service, and resource management. The OIG found that leaders of VHA’s regional networks and medical facilities did not consistently use NSO data to improve operating room efficiency. The audit team estimated (under non-pandemic conditions) that greater regional and facility oversight of surgical support elements would improve operating room efficiency and reduce surgical cancellations by 8,600 over five years, save an estimated $30 million, and improve surgical services for about 7,200 patients. Problems at less efficient facilities persisted for at least two years because regional and facility leaders did not effectively monitor operating room efficiency and follow up when less efficient facilities did not resolve underlying problems in surgical support elements. The surgical workgroups for the less efficient facilities focused primarily on surgical outcomes, while VHA’s more efficient facilities focused on both surgical outcomes and operating room efficiency. VHA concurred with the OIG’s six recommendations, including developing an oversight mechanism to ensure that regional networks monitor and hold medical facilities accountable for addressing persistent problems in operating room efficiency and surgical support elements. Other recommendations address periodic assessments of operating room efficiency data to identify medical facilities with persistent problems, clarifying and refining selected NSO performance measures, identifying best practices and implementing them when appropriate at less efficient facilities, and more broadly sharing efficiency data across medical facility service lines. One recommendation was closed at publication and all others will be monitored until completed.

The OIG reviewed the Veterans Benefits Administration’s (VBA) processing of mail and benefit claims during the COVID-19 pandemic. Specifically, the review team examined whether VBA staff documented the date of receipt for benefits-related correspondence as required by new guidance during the national state of emergency and continued mail operations at VA facilities to ensure benefit claims were processed. Based on its sample analysis, the OIG found VBA staff did not properly apply date of receipt documentation guidance for an estimated 98 percent of 3,200 claims established from April 7 through April 20, 2020. The date of receipt is important because it may be used to establish when veterans become entitled to benefit payments. Veterans could be underpaid if staff record an incorrect date of receipt. However, VBA staff were not always aware of all aspects of documentation guidance and had not received training on it. VBA staff did continue to process mail received at VA facilities, with the postal service forwarding all regional office mail to a scanning facility starting March 31, 2020. Offices that did not have mail automatically forwarded were to have staff available to process incoming mail. The team surveyed regional office staff and found that the majority of regional offices used these methods to continue mail operations. Representatives from veterans service organizations also confirmed that mail operations continued at their offices in Detroit and Los Angeles, where they are colocated with VBA staff. VBA concurred with the OIG’s three recommendations to: (1) ensure VBA staff understand date of receipt guidance for claims received during the pandemic and implement those actions; (2) make certain that claims received and completed from March 1, 2020, had the correct date of entitlement; and (3) evaluate existing guidance for recording the date of receipt for claims without a postmark.

As part of our annual audit plan, we performed an audit to determine the effectiveness of the Tennessee Valley Authority’s (TVA) process for managing heavy equipment provided to contractors through TVA’s Equipment Support Services (ESS) group. ESS provides heavy equipment and other equipment support services to business units across TVA and charges specific projects for the equipment which is provided. ESS’s customers include (1) TVA organizations obtaining services directly or (2) contractors performing work for the TVA organizations. In summary, we determined TVA was not effectively managing contractors’ use of equipment provided by ESS. Specifically, we found:• ESS provides equipment to contractors on TVA projects that have cost reimbursable payment terms. Although ESS does not bill the contractors for the equipment (i.e., ESS charges a TVA project, not the contractor), certain contractors bill TVA for the ESS equipment even though their contract with TVA provides that TVA can only be billed for actual equipment costs. Even though the contractors subsequently provide credits or refunds to TVA for the equipment, it is administratively difficult for TVA to ensure it receives reimbursement for all the costs billed by the contractor.• ESS provides equipment to certain contractors on TVA projects that have fixed price or fixed unit rate payment terms. However, TVA’s Standard Programs and Processes (SPP) do not provide guidelines or processes for TVA to determine the cost effectiveness of providing ESS equipment on fixed price/fixed unit rate projects or to ensure TVA receives the appropriate reductions on the fixed price/fixed unit rates.