Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the request of several members of Congress to assess pain management practices including opioid prescribing and the treatment of substance abuse at Veterans Health Administration (VHA) medical facilities. The OIG found that pain management services were offered at most VA medical facilities, and nearly all facilities offered substance abuse treatment using either methadone or Suboxone®. While the OIG was able to characterize the distribution of pain specialists and pain clinics in VHA, a staffing standard was not identified that would allow determination as to whether this pattern of staffing sufficed to meet demand for pain services. Of the more than 5.7 million VA patients (non-hospice/palliative care) with at least one clinical encounter in fiscal year 2015, the OIG found that 16.7 percent were dispensed opioids. The OIG observed that 93.9 percent of this population had been diagnosed with pain or mental health issues and 56.7 percent of patients with both. The OIG assessed the frequency of higher-risk groups including those veterans prescribed opioid doses greater than 200 morphine equivalents per day or those prescribed both opioids and benzodiazepines. The OIG also examined other practices that reduce the risk of opioid prescribing including the frequency of urine drug testing, use of non-opioid pain treatments such as psychosocial and integrative health, and substance abuse treatment. The OIG made 10 recommendations to the VHA Executive in Charge related to state prescription drug monitoring programs, the number of patients on chronic opioid therapy on a primary care provider’s panel, pain management specialists, pain assessment tools, complementary and integrative health services, urine drug testing, concurrent use of benzodiazepines and opioids, and medication reconciliation.

We visited 14 facilities in the Great Lakes Area, and reviewed all 26,051 accidents, including all 95 serious accidents for FYs 2016 and 2017. We also reviewed employee participation in the Counseling At Risk Employees (CARE) program, which was established to engage employees in accident prevention using accident statistics, root cause analyses, and action plans. Our objective was to determine whether the Postal Service adhered to safety policies and procedures related to accidents in the Great Lakes Area.

We selected to audit the Mid-Carolinas District because it had the second highest extra service costs for fiscal year (FY) 2017 of $6.5 million with a total number of over 12,400 recorded extra trips. We reviewed a statistical sample of 190 PS Form 5429 (e5429), Certification of Exceptional Contract Service Performed representing 84 HCR routes and over 3,900 extra HCR trips in FY 2017. We also conducted site visits or interviews to review the extra trips process at the Processing and Distribution Centers (P&DCs) in Asheville, Charlotte, and Fayetteville, NC, and Greenville, SC. Our objective was to assess the effectiveness of the Postal Service’s extra trip process for Highway Contract Routes (HCRs) in the Mid-Carolinas District.

Effective in 2018, the Medicare program changed the way it sets payment rates for clinical diagnostic laboratory (lab) tests. CMS replaced payment rates with new rates based on charges in the private health care market. This is the first reform in 3 decades to Medicare's payment system for lab tests. As part of the same legislation reforming Medicare's payment system, Congress mandated that OIG monitor Medicare payments for lab tests and the implementation and effect of the new payment system for those tests. This data brief provides the fourth set of annual baseline analyses of the top 25 lab tests.

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