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In response to a congressional request, the VA Office of Inspector General (OIG) conducted a review to examine the Community Living Center (CLC) rating system (Compare), the rating system’s limitations, and what information from the system can reasonably be used to understand the long-term care delivered at CLCs. The OIG found that using star ratings produced by Centers for Medicare and Medicaid Services (CMS) Compare and CLC Compare to examine quality differences between CLCs and CMS participating nursing homes is problematic for several reasons including methodological differences in how the two rating systems collect and analyze data. While metrics can provide a starting point for where to focus additional oversight or areas for potential improvement, they should not be used as a proxy for the overall quality of a facility. Given the complexities and variability among facilities, a single rating score does not, and cannot, provide a comprehensive assessment of a healthcare facility. While these ratings provide selective information about what is occurring in CLCs, they often do not reveal the root cause of the issue or what action should be taken to address a situation if necessary. Despite the limitations associated with using CLC Compare, problematic evaluations still raise concerns about quality of care. It is incumbent on VA to determine whether such evaluations reflect shortcomings in the rating system or the care delivered. The evaluations necessary for these determinations could provide a basis for an improved rating system. The OIG made three recommendations to the Under Secretary for Health related to supplementing CLC Compare with adjustment measures to address CLC and Center for Medicaid and Medicare Services comparison challenges, and developing (a) measures with more rigorous risk adjustment for CLC staffing and quality performance, and (b) a resource that provides an understandable narrative for all.

We selected the Birmingham P&DC for review based on our analysis of manual flats productivity as measured by the Management Operating Data System (MODS). The Postal Service uses MODS data to plan workload, forecast workhours and mail volume, track mail processing activities, evaluate the efficiency of facilities, and estimate staffing requirements. In addition to its operational uses, the Postal Service uses MODS workhour data to calculate totals for many of the cost pools within the Clerks and Mail Handlers Cost Segment. Postal Service management and the Postal Regulatory Commission rely on accurate and precise product cost estimates to set postal prices and to reliably determine whether revenue for products and mail classes covers attributable costs. The Birmingham P&DC’s FY 2019 manual flats productivity of 100 mailpieces per hour was significantly lower than the national average productivity of 332 mailpieces per hour. Our objective was to assess manual flats processing operations at the Birmingham P&DC.

The Federal Information Security Modernization Act of 2014 (FISMA) requires each agency’s Inspector General (IG) to conduct an annual independent evaluation to determine the effectiveness of the information security program (ISP) and practices of its respective agency. Our objective was to evaluate the Tennessee Valley Authority’s ISP and agency practices for ensuring compliance with FISMA and applicable standards, including guidelines issued by Office of Management and Budget and National Institute of Standards and Technology. Our audit scope was limited to answering the FY 2019 IG FISMA metrics developed as a collaborative effort by the Office of Management and Budget, Department of Homeland Security, and Council of Inspector Generals on Integrity and Efficiency in consultation with the Federal Chief Information Officer Council. The FY 2019 IG FISMA metrics recommend a majority of the functions be at a maturity level 4 (managed and measurable) or higher to be considered effective. Based on our analysis of the metrics and associated maturity levels defined with the IG FISMA metrics, we found three of the five functions fell below the targeted level 4; therefore, TVA’s ISP was not operating in an effective manner. We made eight specific recommendations to TVA management to make improvements in the ISP.