The Veterans Administration’s new resource allocation process uses a standardized electronic model, but the transparency of networks' decisions for allocating resources to medical centers is limited, a new GAO report concludes.
[Editor's Desk: This Week in Government Health IT.]
In its April 29 report, GAO recommends that the VA require networks to provide rationales for all adjustments made to allocations proposed by VA's resource allocation model, and that it develop written policies to document practices for monitoring resources. The VA concurred with these recommendations.
The new process involves three steps:
- First, VA headquarters proposes medical center allocation amounts to networks using a standardized resource allocation model. The model includes a standardized measure of workload that recognizes the varying costs and levels of resource intensity associated with providing care for each patient at each medical center.
- Second, network officials review the proposed amounts and have the flexibility to adjust them if they believe that certain medical centers' resource needs are not appropriately accounted for in the model.
- Third, networks report final medical center allocation amounts to VA headquarters and any adjustments made to the allocation amounts proposed by the model.
VA headquarters did not ask networks to report reasons for each adjustment made to allocation amounts; networks reported reasons for some adjustments, but not for others.
VA officials said that the new network resource allocation process was not intended to be used to question networks' decision making, but to increase the transparency of networks' allocation decisions to VA headquarters while maintaining network flexibility.
However, absent rationales from networks on all adjustments made to medical center allocation amounts, transparency for decisions made through the allocation process is limited. Furthermore, understanding why networks make adjustments is key in determining if any modifications to the model are needed for subsequent years.
VA officials told GAO that they intend to conduct annual assessments of the new resource allocation process, including a review of adjustments to the model, to identify areas for improvement.
[See also: VA, DOD to incorporate open source in EHR.]
VA centrally monitors the resources networks have allocated to medical centers to ensure spending does not exceed allocations, but does not have written policies documenting these practices for monitoring resources. VA monitors resources through two primary practices – automated controls in its financial management system and regular reviews of network spending.
Specifically, VA's financial management system electronically tracks the amount of resources that networks and medical centers have available--the resources allocated, less the resources already spent--and prevents medical centers from spending more than what they have available by rejecting spending requests in excess of available resources.
In addition, each month VA headquarters officials compare each network's spending with what the network planned to spend and determine whether spending is on target, and whether any differences from the plan are significant.
However, VA headquarters does not have written policies documenting the agency's practices for monitoring resources, which is not consistent with federal internal control standards. These standards state that internal controls should be documented, and all documentation should be properly managed, maintained, and readily available for examination.
Without written policies, there is an increased risk of inconsistent monitoring of VA network and medical center resources.
This article was originally posted at http://ping.fm/UT5ro