Resource Sharing Activities Result in Better Access and Reduced Costs

VA and DOD are realizing benefits from sharing activities, specifically  greater access to care, reduced federal costs, and better facility utilization  at the 16 sites we reviewed. While all 16 sites were engaged in health  resource sharing activities, some sites share significantly more resources  than others. Through this agreement VA is able to utilize Navy facilities and reduce its  reliance on civilian providers, thus lowering its purchased care cost by  about $385,000 annually. Further, according to a VA official, the agreement  has allowed VA to modify its plans to build a new hospital and instead  build a clinic at significantly reduced cost to meet increasing veteran  demand for health care services. For example, the  sharing agreement at Los Angeles provided for the use of a nurse  practitioner to assist with primary care and the sharing of a psychiatrist  and a psychologist. See appendix II for the VA and DOD partners at each  of the 16 sites and examples of the sharing activities taking place. VA and DOD Identified Two Obstacles that Impede Resource Sharing

The primary obstacle cited by officials at 14 of 16 sites we interviewed was  the inability of computer systems to communicate and share patient health  information between departments. Furthermore, local VA and DOD  officials involved with sharing activities raised a concern that security  check-in procedures implemented since September 11, 2001, have  increased the time it takes to gain entry to medical facilities located on  military installations during periods of heightened security. The inability of VA and DOD computer systems to share information  forces the medical facilities involved in treating both agencies’ patient  populations to expend staff resources to maintain patient records in both  systems. VA  and DOD generally agreed with our findings. Appendix I: Scope and Methodology

This report describes the benefits that are being realized at 16 Department  of Veterans Affairs (VA) and Department of Defense (DOD) sites that are  engaged in health resource sharing activities. Nine of the sites were the  focus of a February 2002 House Committee on Veterans’ Affairs report  that described health resource sharing activities between VA and DOD. We  selected seven other sites that actively participated in sharing activities to  ensure representation from each service at locations throughout the  nation. To gain information on the benefits of sharing and the problems that  impede sharing at selected VA and DOD sites, we asked VA and DOD  personnel at 16 sites to provide us with information on:    shared services provided to beneficiaries including improvements or  enhancements to delivery of health care to beneficiaries,  reduction in costs,    and their opinions on barriers or obstacles that exist either internally  (within their own agency) or externally (with their partner service or  agency).
Why GAO Did This Study

Congress has long encouraged the Department of Veterans Affairs (VA) and the Department of Defense (DOD) to share health resources to promote cost-effective use of health resources and efficient delivery of care. In February 2002, the House Committee on Veterans' Affairs described VA and DOD health care resource sharing activities at nine locations. GAO was asked to describe the health resource sharing activities that are occurring at these sites. GAO also examined seven other sites that actively participate in sharing activities. Specifically, GAO is reporting on (1) the types of benefits that have been realized from health resource sharing activities and (2) VA- and DOD-identified obstacles that impede health resource sharing. GAO analyzed agency documents and interviewed officials at DOD and VA to obtain information on the benefits achieved through sharing activities. The nine sites reviewed by the Committee and reexamined by GAO are: 1) Los Angeles, CA; 2) San Diego, CA; 3) North Chicago, IL; 4) Albuquerque, NM; 5) Las Vegas, NV; 6) Fayetteville, NC; 7) Charleston, SC; 8) El Paso, TX; and 9) San Antonio, TX. The seven additional sites GAO examined are: 1) Anchorage, AK; 2) Fairfield, CA; 3) Key West, FL; 4) Pensacola, FL; 5) Honolulu, HI; 6) Louisville, KY; and 7) Puget Sound, WA. In commenting on a draft of this report, the departments generally agreed with our findings.

What GAO Found

At the 16 sites GAO reviewed, VA and DOD are realizing benefits from sharing activities, specifically better facility utilization, greater access to care, and reduced federal costs. While all 16 sites are engaged in health resource sharing activities, some sites share significantly more resources than others. For example, at one site VA was able to utilize Navy facilities to provide additional sources of care and reduce its reliance on civilian providers, thus lowering its purchased care cost by about $385,000 annually. Also, because of the sharing activity taking place at this site, VA has modified its plans to build a new $100 million hospital and instead plans to build a clinic that will cost about $45 million. However, at another site the sharing activity was limited to the use of a nurse practitioner to assist with primary care and the sharing of a psychiatrist and a psychologist. GAO found that the primary obstacle cited by almost all of the agency officials interviewed was the inability of VA and DOD computer systems to communicate and exchange patient health information between departments. VA and DOD medical facilities involved in treating both agencies' patient populations must expend staff resources to enter information on the health care provided into the patient records in both systems. Local VA officials also expressed a concern that security screening procedures have increased the time it takes for VA beneficiaries and their families to gain entry to facilities located on Air Force, Army, and Navy installations during periods of heightened security.